THE  HISTORY  OF  MEDICINE 

In  its  Salient  Features 


JOHN  HUNTER 
Painted  by  Sir  Joshua  Reynolds 


THE  HISTORY  OF 
MEDICINE 

In  its  Salient  Features 

BY 
WALTER  LIBBY,  M.A.,  PH.D. 

UNIVERSITY  OF  PITTSBURGH  ;   AUTHOR  OF  "AN   INTRODUCTION 
TO  THE  HISTORY  OF  SCIENCE*' 

WITH  ILLUSTRATIONS 


BOSTON  AND  NEW  YORK 

HOUGHTON  MIFFLIN  COMPANY 

Cije  Htbcrsfbe  rjOrrss  Cambridge 
1922 


COPYRIGHT,  IQ22,  BY  WALTER  LIBBY 
ALL  RIGHTS  RESERVED 


CAMBRIDGE  .  MASSACHUSETTS 
PRINTED  IN  THE  U.S.A. 


PREFACE 

IN  the  closing  days  of  1917  I  was  asked  to  give  a 
course  of  lectures  on  the  history  of  medicine.  This 
book  is  the  outcome  of  my  attempt  to  comply  with 
the  request  made  at  that  time.  The  course  of  lec- 
tures, given  in  the  first  place  in  the  early  weeks  of 
1918,  followed  the  lines  of  the  present  table  of  con- 
tents. My  auditors  were  third-year  students  in  one 
of  the  American  Schools  of  Medicine,  and  the  plan  of 
presentation  was  more  or  less  consciously  dictated, 
at  the  start,  by  the  recollection  of  what  had  chal- 
lenged my  curiosity  and  aroused  my  attention  about 
the  time  I  had  attained  a  like  standing  as  a  student 
of  medicine.  Questions  and  class  discussions  evoked 
by  the  lectures  in  1918  and  the  three  subsequent 
years  suggested,  however,  certain  modifications  of 
the  initial  treatment  of  the  subject  and  indicated 
in  what  directions  additions  and  elucidations  were 
most  desirable. 

Even  at  the  outset  I  felt  sure  that  the  course 
would  be  of  greater  interest  to  the  men  if  I  could 
trace  the  development  of  medicine,  however  suc- 
cinctly, from  the  earliest  times  till  the  present  day. 
I  began,  therefore,  with  an  account  of  the  dawn  of 
medical  science  in  Egypt  and  Babylonia,  in  spite  of 


vi  PREFACE 

the  imperfect  state  of  the  records  and  their  need 
of  interpretation.  Nor  could  I  refrain  —  in  April, 
1918  —  from  saying  at  least  something  concerning 
"Medical  Science  and  Modern  Warfare,"  although 
the  time  had  obviously  not  arrived  for  setting  forth 
adequately  the  medical  aspects  of  the  World  War. 
Similarly,  the  distribution  of  space  as  regards  an- 
cient and  modern  medicine,  the  emphasis  of  what 
seemed  to  me  the  most  important  stages  in  the  evo- 
lution of  medicine,  the  avoidance  of  unnecessary  de- 
tails and  of  needlessly  abstruse  terminology,  as  well 
as  the  general  style  of  composition,  have  their  ex- 
planation in  the  nature  of  the  audience  before  whom 
and  of  the  circumstances  in  which  the  course  of  lec- 
tures was  given.  By  the  use  of  simple  reading  lists, 
now  represented  by  the  References  at  the  ends  of 
the  chapters,  I  hoped  so  to  interest  the  students 
that  they  would  soon  become  capable  of  construct- 
ing their  own  bibliographies,  and  that  from  the  pe- 
rusal of  Allbutt,  Garrison,  Guerini,  Hyrtl,  Meunier, 
Osier,  Singer,  Sudhoff,  Withington,  and  other  au- 
thorities brought  to  their  particular  attention,  they 
might  pass  to  an  examination  of  Baas-Handerson, 
Buck,  Choulant,  Daremberg,  Diels,  Friend,  Haeser, 
Hollander,  Ideler,  Ilberg,  Le  Clerc,  Littr6,  Meyer- 
Steineg,  Neuburger,  Pagel,  Puschmann,  Schelenz, 
Schwalbe,  Sprengel,  Wellmann,  Wickersheimer,  and 
other  more  or  less  distinguished  writers  on  the  his- 


PREFACE  vii 

tory  of  medicine.  Garrison's  Introduction  to  the  His~ 
tory  of  Medicine  (third  edition,  1921)  is  a  compre- 
hensive and  up-to-date  work  almost  indispensable 
to  the  serious  student  of  the  subject  it  treats.  I  am 
especially  conscious  of  my  indebtedness  to  it,  to  the 
Histoire  de  la  Medecine  of  L£on  Meunier,  to  the 
Geschichte  der  Medizin  of  Max  Neuburger,  and  to 
the  Medical  History  of  E.  T.  Withington,  of  whose 
translations  I  have  made  use  in  the  second  chapter. 
Through  an  almost  inexplicable  oversight  I  failed 
to  mention  in  the  preface  of  An  Introduction  to  the 
History  of  Science  the  "Science  Room"  at  the  Bodle- 
ian Library,  Oxford,  where  that  book  was  written. 
Some  of  the  researches  there  carried  on  by  Dr. 
Charles  Singer  and  those  associated  with  him  have 
been  embodied  in  two  handsome  volumes  —  Studies 
in  the  History  and  Method  of  Science  (1917,  1921).  I 
take  this  opportunity  of  expressing  my  sense  of  obli- 
gation to  him,  as  well  as  to  Dr.  George  Sarton,  of 
the  Carnegie  Institution,  editor  of  I  sis  and  exponent 
on  this  continent  of  the  claims  of  the  history  of 
science.  I  wish  also  to  thank  Dr.  Edna  M.  Guest, 
of  Toronto,  for  advice  in  reference  to  all  the  chap- 
ters which  she  read  in  manucript,  and  for  sub- 
stantial help  in  the  revision  of  the  twentieth  chap- 
ter, —  help  which  her  military  experience  in  the 
East,  as  well  as  on  the  Western  front,  rendered 
invaluable.  All  interested  in  the  history  of  the 


viii  PREFACE 

medical  sciences  as  well  as  of  science  in  general 
will  welcome  the  announcement  of  a  work  by  Pro- 
fessor Lynn  Thorndike  on  The  History  of  Magic,  and 
of  a  History  of  Biology  from  the  pen  of  Professor 
W.  A.  Locy. 

WALTER  LIBBY 
September,  1922 


CONTENTS 

I.  THE   PRIEST-PHYSICIANS   OF   EGYPT   AND 

BABYLONIA  i 

II.  HIPPOCRATES  THE  FATHER  OF  MEDICINE         23 

III.  ROMAN  ANATOMY  AND  SURGERY  46 

IV.  THE  TRANSMISSION  OF  MEDICAL  SCIENCE 

BY  THE  ARABS  71 

V.  THE  REVIVAL  OF  ANATOMY  AND  SURGERY  IN 

THE  SIXTEENTH  CENTURY  94 

VI.  WILLIAM  HARVEY  AND  THE  REVIVAL  OF 

PHYSIOLOGY  116 

VII.  SCIENCE  AND  PRACTICE: 

SYDENHAM,  BOERHAAVE  138 

VIII.  COMPARATIVE  ANATOMY: 

JOHN  HUNTER  160 

IX.  MORBID  ANATOMY,  AND  HISTOLOGY: 

MORGAGNI,  BlCHAT  l8l 

•tt  X.  LOCAL  DIAGNOSIS:  * 

AUENBRUGGER,  LAENNEC  2OO 

XI.  ADVANCES  IN  PHYSIOLOGY    *  218 

XII.  EMBRYOLOGY  AND  KARL  ERNST  VON  BAER    238 

XIII.  THE  CELL-THEORY  AND  CELLULAR  PATH- 

OLOGY 257 

XIV.  THE  INTRODUCTION  OF  ANAESTHETICS  276 
XV.  THE  THEORY  OF  ORGANIC  EVOLUTION  296 

XVI.  THE  FOUNDERS  OF  BACTERIOLOGY  316 

XVII.  ANTISEPTIC  SURGERY:  LORD  LISTER  335 


x  CONTENTS 

XVIII.  THE  HISTORY  OF  SYPHILIS  354 

XIX.  PREVENTIVE  MEDICINE  IN  THE  TROPICS  374 

XX.  MEDICAL  SCIENCE  AND  MODERN  WARFARE  396 

'  INDEX  415 


ILLUSTRATIONS 
JOHN  HUNTER  Frontispiece 

From  the  photogravure  in  William  Stirling's  Some  A  poslles 
of  Physiology  (London,  1902)  of  the  portrait  by  Sir  Joshua 
Reynolds  in  the  Royal  College  of  Surgeons,  London. 

FACSIMILES  FROM  THE  EBERS  PAPYRUS  IN  EGYPTIAN 
HIERATIC  CHARACTERS,  CONTAINING  DENTAL  PRE- 
SCRIPTIONS 6 

From  Guerini's  History  of  Dentistry. 

HIPPOCRATES  32 

From  an  engraving  by  W.  Skelton,  in  Thomas  Joseph  Petti- 
grew's  Medical  Portrait  Gallery,  of  the  bust  found  near 
Albano  among  ruins  supposed  to  have  been  the  villa  of 
Marcus  Varro.  The  bust  is  now  in  the  British  Museum. 

DISSECTION  SHOWING  THE  FEMALE  VISCERA  IN  SITU, 
DRAWN  BY  LEONARDO  DA  VINCI,  circa  1510  104 

From  Quaderni  d'Anatomia. 

MARIE-FRAN^OIS-XAVIER  BICHAT  190 

From  William  Stirling's  Some  Apostles  of  Physiology. 

FRANCOIS  MAGENDIE  190 

From  Some  Apostles  of  Physiology. 

SIR  CHARLES  BELL  222 

From  an  engraving  by  J.  Thomson  in  Pettigrew's  Medical 
Portrait  Gallery,  after  the  portrait  by  Ballantyne. 

LORD  LISTER  346 

From  a  photogravure  in  Sir  Rickman  Godlee's  Life  of 
Lord  Lister. 

PLASTIC  SURGERY  OF  THE  FACE  412 

From  H.  D.  Gillies's  Plastic  Surgery  of  the  Face,  Oxford, 
1920. 


THE   HISTORY  OF   MEDICINE 

In  its  Salient  Features 

•  • 
• 

CHAPTER  I 

THE  PRIEST-PHYSICIANS  OF  EGYPT  AND 
BABYLONIA 

THE  medical  lore  of  a  very  remote  past  was  handed 
down  from  generation  to  generation  by  the  Egyp- 
tian priests,  the  overseers  of  the  general  welfare  of 
the  people,  to  become  ultimately  known,  at  least  in 
part,  to  Hippocrates  and  other  Greeks  of  the  Peri- 
clean  age.  The  tendency  to  perpetuate  traditional 
teachings  and  practices,  natural  to  the  priestly 
caste  everywhere,  was  enhanced  in  Egypt  through 
the  early  development  of  the  hieroglyphic  and  hi- 
eratic systems  of  writing  from  the  pictorial,  and 
encouraged  by  the  preservative  nature  of  the  dry 
Egyptian  climate.  The  written  records  of  the  scribes 
and  clerics,  their  incantations,  spells,  exorcisms, 
prescriptions,  and  clinical  observations,  were  main- 
tained intact  from  age  to  age,  and  finally  embodied 
in  compilations,  of  which  a  few  specimens  survive  in 
the  medical  papyri  of  our  libraries  and  museums. 
At  the  same  time  the  ease  with  which  the  dead 


2         THE  HISTORY  OF  MEDICINE 

could  be  preserved  from  putrefaction  in  the  plateaus 
above  the  Nile  Valley  led  to  improved  methods  of 
tomb  construction,  which  culminated  in  the  erec- 
tion of  the  pyramids  between  the  thirtieth  and 
twenty-fifth  centuries,  as  well  as  to  the  develop- 
ment of  the  art  of  embalming,  which  reached  its 
highest  perfection  about  the  middle  of  the  sixteenth 
century,  B.C.  It  is  natural  to  find  that  in  these 
circumstances  therapeutics  and  religious  supersti- 
tion were  not  mutually  exclusive,  and  that  the 
efforts  of  the  Egyptian  priest-physicians  to  pro- 
mote hygienic  living  and  the  attainment  of  longevity 
were  closely  associated  with  a  transcendental  vision 
of  a  material  life  everlasting. 

In  Egypt  more  clearly  than  elsewhere  can  be 
traced  a  rapid  advance  from  barbarism  to  a  high 
degree  of  civilization.  In  the  Nile  Delta,  not  far 
from  the  pyramids,  are  still  to  be  seen  the  graves  of 
neolithic  man  containing  such  evidence  of  his  primi- 
tive industries  as  stone  implements,  pottery,  frag- 
ments of  linen,  grains  of  barley  and  split  wheat. 
These  graves  are  not  unlike  those  of  primitive  and 
prehistoric  men  elsewhere,  as,  for  example,  the 
graves  of  some  of  the  aborigines  of  North  America. 
In  fact,  the  early  Egyptian,  watering  his  fields  by 
a  simple  system  of  irrigation,  living  in  huts  of 
mud-brick,  employing  an  undeveloped  method  of 
chronology,  and  unacquainted  with  copper  or  iron, 


THE  PRIEST-PHYSICIANS  3 

is  in  many  respects  comparable  with  the  ancient 
Pueblo  Indian  of  New  Mexico  and  Arizona.  The 
transition  to  a  more  advanced  stage  of  development 
came  for  the  Egyptians  when  in  the  fifth  millennium 
B.C.  they  added  to  the  use  of  gold  and  the  rarer 
silver  that  of  copper,  found  native  or  obtained  by 
smelting  from  malachite.  This  acquisition  led  in 
turn,  about  the  middle  of  the  thirty-first  century, 
to  the  employment  of  prepared  stone  as  building 
material,  and,  about  the  beginning  of  the  thirtieth 
century,  to  the  erection  of  the  first  pyramid.  This 
step-pyramid  was  de  signed  by  Imhotep,  the  first  of 
the  priest-physicians  whose  name  is  known  to  us. 
In  later  centuries  his  memory  was  held  sacred  in 
hundreds  of  temples,  and  he  became  identified  in 
the  minds  of  many  Egyptians  with  Thoth,  the  god 
of  healing. 

It  is  not  strange  that  some  resemblance  should 
exist  between  the  surgery  of  Egypt,  where,  in  the 
desert  sands,  stone  tools  and  flint  arrowheads  are 
still  to  be  found,  and  the  surgery  of  primitive  and 
prehistoric  peoples.  Before  the  dawn  of  history 
trephining,  cupping,  circumcision,  castration,  vene- 
section, the  use  of  the  cautery  and  of  splints  were 
known  in  many  parts  of  the  earth;  though  the 
motives  that  led  to  the  employment  of  these  prac- 
tices were  not  in  each  case  identical  with  those  of 
modern  surgery.  Skulls  recovered  by  the  archae- 


4        THE  HISTORY  OF  MEDICINE 

ologist  bear  witness  that  trephining  was  practiced 
among  prehistoric  peoples  in  the  western  as  well  as 
in  the  eastern  hemisphere.  It  was  performed  for  a 
variety  and  mixture  of  motives  —  to  relieve  head- 
ache, to  cure  epilepsy,  to  let  out  the  tormenting 
spirit,  to  obtain  amulets,  or  to  propitiate  the  gods. 
Even  among  primitive  peoples  to-day  trephining  is 
sometimes  effected  by  means  of  knives  of  flint  or 
obsidian.  A  slight  link  is  established  between  the 
surgery  of  barbarian  and  that  of  civilized  Egypt 
by  some  representations  of  surgical  operations  of 
2500  B.C.  They  were  discovered  on  the  doorpost  of  a 
tomb  in  a  necropolis  near  Memphis.  Among  the 
pictures  are  two  of  circumcisions,  in  which  the 
surgeon  is  shown  in  the  act  of  operating  with  a  flint 
knife.  The  Jews,  who  learned  this  adolescent  rite 
from  the  Egyptians,  were  still  in  their  ceremonies 
using  the  same  sort  of  neolithic  instrument  cen- 
turies later,  as  we  know  from  the  fifth  chapter  of 
the  Book  of  Joshua. 

On  account  of  the  conservatism  of  the  priest- 
physicians,  Egyptian  medicine  never  advanced  far 
beyond  primitive  medicine  with  its  simple  faith  in 
magic  spells  and  the  virtue  of  a  rich  pharmacopoeia, 
and  its  belief  that  the  cause  of  disease  was  the 
malice  of  a  demon,  the  justice  of  an  avenging  god, 
the  ill-will  of  an  enemy,  or  the  anger  of  the  dead. 
The  medicine,  chest  of  an  early  Egyptian  queen 


THE  PRIEST-PHYSICIANS  5 

(about  2100  B.C.),  with  its  alabaster  bottles  con- 
taining medicinal  roots,  is  typical  of  the  Egyptian 
faith  in  the  efficacy  of  drugs.  In  the  London  papyrus, 
the  lesser  Berlin  papyrus,  and  the  Brugsch  papyrus 
the  mystical  element  predominates,  though  in  the 
last-named  we  read  of  vermifuges,  fumigations, 
treatment  of  ulcers,  of  haematuria,  of  diseases  of  the 
breast,  heart,  and  ears.  The  Ebers  papyrus,  the 
discovery  of  which  was  announced  in  1873,  though 
by  no  means  wanting  in  charms  and  incantations, 
is  less  dominated  by  the  mystical  element  than  the 
preceding  or  succeeding  medical  papyri.  It  is  a 
compilation  of  about  the  middle  of  the  sixteenth 
century  B.C.  Much  of  it  reflects,  however,  the 
practice  of  an  earlier  epoch,  and  it  may  be  con- 
sidered as  representing  the  high- water  mark  of 
Egyptian  medicine. 

It  is  in  the  main  a  collection  of  prescriptions,  some 
of  which  had  been  tried  frequently,  as  we  learn  from 
marginal  notes,  and  found  good,  or  excellent.  It 
makes  mention  of  some  seven  hundred  remedies, 
evidently  accumulated  in  the  course  of  the  ages,  and 
put  on  record  and  preserved  for  posterity  by  the 
priestly  scribes.  Among  the  remedies  are  found 
poppy,  castor-oil,  gentian,  colchicum,  squills,  aloes, 
cedar,  mint,  myrrh,  crocus,  hyoscyamus,  caraway, 
elderberries,  and  many  other  medicinal  herbs,  that 
call  to  mind  the  therapy  of  North  American  In- 


6         THE  HISTORY  OF  MEDICINE 

dians  and  of  all  primitive  tribes  throughout  the 
world.  The  Egyptian  priest-physicians  made  use 
also  of  certain  inorganic  remedies,  such  as  lead 
oxide,  earthy  carbonate  of  lead,  galena,  meteoric 
iron,  blue  vitriol,  crude  carbonate  of  soda,  sodium 
chloride,  and  sea-salt.  Petroleum,  bog-water,  goose- 
oil,  turpentine,  ink  (made  from  charcoal  and  gum), 
honey,  probably  antimony,  possibly  mercurials, 
found  a  place  in  the  Egyptian  pharmacopoeia. 
Honey  was  thought  to  be  terrible  to  the  dead, 
though  sweet  to  man.  It  may  have  been  on  the 
complementary  principle  that  what  is  abhorrent  to 
the  patient  is  pleasant  to  the  perverse  demons  of 
disease  that  many  disgusting  substances  were  used 
as  remedies,  such  as  the  dung  of  the  gazelle  and  the 
crocodile,  the  fat  of  a  serpent,  mammalian  entrails, 
and  other  excreta,  tissues,  and  organs.  In  some 
cases  the  object  seems  to  have  been  to  wheedle,  in 
other  cases  to  repel,  the  evil  spirits  that  had  taken 
possession  of  the  patient.  The  various  medicines 
were  given  as  foods,  potions,  pills,  plasters,  in- 
unctions, inhalations,  etc. 

Among  the  diseases  spoken  of  in  the  Ebers 
papyrus  are  ailments  of  the  eyes  and  ears,  stomach 
troubles,  worms,  dysentery,  and  other  affections 
of  the  intestines,  arthritis  deformans,  gout,  lum- 
bago, ascites,  pemphigus,  scurvy,  leucorrhcea, 
asthma,  tumors,  and  a  disease  which  some  would 


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FACSIMILES    FROM    THE    EBERS    PAPYRUS    IN    EGYPTIAN 

HIERATIC  CHARACTERS,  THE  UPPER  CONTAINING  THREE, 

THE  LOWER  ELEVEN,  DENTAL  PRESCRIPTIONS 


THE  PRIEST-PHYSICIANS  7 

identify  as  hookworm  disease  (Egyptian  chlorosis), 
others  with  bilharziasis.  Both  of  these  last-named 
diseases  are  very  prevalent  in  Egypt  at  the  present 
time;  both  are  marked  by  anaemia  and  are  asso- 
ciated with  arrest  of  mental  development;  both 
are  now  known  to  be  caused  by  parasitic  worms, 
the  former  by  Ancylostoma  duodenale  (and  Necator 
americanus) ,  the  latter  by  Schistosoma  hcematobium. 
Haematuria  is  one  of  the  most  constant  symptoms 
of  bilharziasis,  a  fact  which  may  have  some  bearing 
on  the  identification  of  the  disease  mentioned  in  the 
Ebers  papyrus,  for  the  symbol  there  used  for  the 
disease  is  the  phallus.  As  we  shall  see  in  the  six- 
teenth chapter,  some  of  the  other  diseases  treated 
in  the  Egypt  of  the  sixteenth  century  B.C.  have  in 
recent  times  been  studied  by  one  of  the  leading 
bacteriologists. 

A  few  passages  of  the  Ebers  papyrus  may  bear 
witness  to  a  knowledge  of  anatomy,  surgery,  and 
diagnosis  somewhat  beyond  the  range  of  primitive 
and  prehistoric  peoples.  One  of  these  reads:  "If 
the  physician  place  his  finger  on  the  head,  neck, 
hands,  arms,  feet,  or  trunk,  everywhere  he  will  find 
the  heart,  for  its  vessels  go  to  all  parts."  The 
vessels  of  the  body  are  said  to  run  in  pairs,  and  to 
contain  not  merely  blood,  but  air,  water,  milk,  and 
other  fluids.  Another  passage  says:  "When  you 
find  a  man  with  a  stoppage,  his  face  pale  and  heart 


8        THE  HISTORY  OF  MEDICINE 

*» 

palpitating,  and  you  find  upon  examination  that 
his  heart  is  hot  and  his  belly  swollen,  that  is  an 
affection  caused  by  irritant  food.  Treat  it  with 
something  that  is  cooling  and  aperient,  especially 
with  a  draught  of  sweet*  beer,  poured  upon  dry 
nequat  fruit.  Four  times  shall  he  eat  or  drink."  A 
third  passage  advises  operation  following  diagnosis 
of  fatty  tumor:  "If  you  find  disease  of  fat  in  any 
part  whatsoever  of  the  body  of  the  person,  and  find 
that  it  moves  hither  and  thither  under  your  fingers, 
and  that  it  trembles  when  your  hand  is  at  rest,  then 
you  must  say  of  it,  'It  is  a  fatty  tumor;  it  pains;  I 
will  treat  it.'  Treat  it  with  the  knife;  dress  it  as  one 
dresses  open  wounds." 

The  Ebers  papyrus  is  not  only  the  most  important 
source  of  information  concerning  ancient  Egyptian 
medicine,  but  the  most  complete  book  on  any  sub- 
ject that  has  come  down  to  us  from  those  remote 
times.  The  Kahun  papyrus  consists  of  two  parts, 
the  first  gynecological,  the  second  veterinary.  The 
Hearst  papyrus,  recovered  by  the  Hearst  Egyptian 
Expedition  of  the  University  of  California,  is  in 
content  identical  with  a  part  of  the  Ebers  papyrus; 
they  belong  to  the  same  epoch. 

A  study  of  the  art  of  embalming  and  an  examina- 
tion of  mummies  and  other  human  remains  throw 
light  on  the  medical  science  of  different  periods  of 
Egyptian  history,  as  well  as  on  the  various  diseases 


THE  PRIEST-PHYSICIANS  9 

to  which  the  ancient  Egyptians  were  subject.  At 
the  same  time  we  are  afforded  a  glimpse  of  the  in- 
juries to  which  they  were  especially  liable,  and  of 
the  methods  of  surgical  treatment.  Embalming  is, 
of  course,  of  particular  interest  to  us  because  of  the 
knowledge  of  anatomy  it  involved  and  because  it 
was  essentially  an  antiseptic  art.  Any  brief  descrip- 
tion of  embalming  is  likely  to  prove  an  imperfect  or 
a  composite  picture,  for  the  procedure  was  by  no 
means  uniform.  Evisceration  of  the  dead  was  to 
some  extent  customary  before  the  sixteenth  cen- 
tury B.C.,  and  the  fact  that  the  ceremonial  flint 
knife  was  always  used  to  make  the  incision  in  the 
abdomen  indicates  that  the  practice  had  a  very 
early  origin.  After  the  embalmer's  art  had  reached 
its  highest  development,  the  brain  was  sometimes 
removed  by  means  of  an  iron  or  bronze  hook,  which 
reached  the  interior  of  the  skull  from  the  nose  by 
perforating  the  cribriform  plate  of  the  ethmoid 
bone  or  by  tunneling  the  sphenoid.  The  cavity  was 
then  cleansed  with  a  solution  of  drugs.  This  diffi- 
cult operation  of  removing  the  brain  was  as  a  rule 
quite  successful,  though  the  less  expert  occasionally 
broke  through  into  the  orbital  cavities,  or  even 
fractured  the  frontal  bone  from  within.  As  already 
implied,  the  intestines,  stomach,  liver,  and  spleen 
were  removed  generally  through  an  opening  made 
in  the  abdominal  wall.  This  was  on  the  left  side, 


io       THE  HISTORY  OF  MEDICINE 

probably  to  allow  free  play  to  the  right  arm  of  the 
operator.  In  some  cases  the  lungs  were  also  re- 
moved by  piercing  the  back  part  of  the  diaphragm 
or  by  removing  that  muscle.  The  heart  and  kidneys 
might  be  left  in  situ.  After  the  organs  had  been 
removed,  the  body  was  rinsed  out  with  wine,  myrrh, 
cassia,  etc.  At  times,  instead  of  making  an  incision 
in  the  abdomen,  the  embalmer  injected  a  solution 
of  cedar-oil,  which  acted  as  a  solvent  on  the  viscera, 
which  then  were  removed  through  the  anus.  The 
body  was  now  kept  for  seventy  days  in  a  saline 
solution,  a  solution,  for  example,  of  crude  carbonate 
of  soda  (natron)  found  native  in  different  parts  of 
Egypt.  Finally  it  was  bandaged  and  wrapped  in 
linen  smeared  with  gums  or  wax.  Resin  and  pitch 
were  used  extensively,  as,  indeed,  the  terms  "em- 
balm" and  "mummy"  imply. 

During  the  last  few  years  mummies  and  other 
human  remains  have  been  examined  with  the  pur- 
pose of  determining,  as  far  as  possible,  the  diseases 
and  injuries  from  which  the  ancient  Egyptians 
suffered.  These  belated  autopsies,  numerous  as 
they  have  been,  afford  no  evidence  of  syphilis, 
little  or  no  evidence  of  rickets  (though  there  are  on 
record  cases  of  distortion  difficult  to  ascribe  to  any 
other  cause,  as  well  as  a  case  of  achondroplasia),  and 
no  evidence  of  tuberculosis  except  as  involved  in 
Pott's  disease,  an  extreme  form  of  which  is  exhibited 


THE  PRIEST-PHYSICIANS  11 

in  the  mummy  of  a  priest  of  Ammon  of  about 
1000  B.C.  Thousands  of  bodies  exhumed  in  Nubia, 
in  the  vicinity  of  the  Assuan  Dam,  show  on  exami- 
nation that  the  Egyptians  suffered  but  little  from 
pyogenic  infections,  that  the  death-rate  of  children 
was  much  lower  in  ancient  than  in  modern  Egypt, 
and  that  in  the  earlier  and  less  luxurious  epochs  few 
of  the  inhabitants  of  the  region  suffered  from  pre- 
mature decay  of  the  teeth.  At  no  period  is  there  any 
sign  of  filled  or  of  artificial  teeth,  and  even  as  late  as 
the  sixteenth  century  B.C.  a  large  proportion  of 
adults  in  some  districts  were  able  to  show  perfect 
sets  of  teeth, 

The  examination  of  bodies  belonging  to  all 
periods  of  Egyptian  history  shows  the  prevalence  of 
the  disease  now  known  as  arthritis  deformans,  of 
which  mention  has  already  been  made.  It  is  de- 
scribed as  the  bone  disease  par  excellence  of  the 
ancient  Egyptians.  It  still  afflicts  the  inhabitants 
along  the  course  of  the  Nile.  Its  etiology  is  uncer- 
tain, but,  though  the  view  predominates  that  it  is 
a  chronic  infection,  wet  and  damp  may  be  among 
the  exciting  causes.  In  the  Egyptian  cases  that  have 
been  examined  the  vertebrae  are  sometimes  involved, 
as  also  the  shafts  of  the  bones.  Cases  of  vesical 
calculus  of  the  fourth  millennium,  renal  calculus  of 
the  third  millennium,  gall-stones  of  the  third  millen- 
nium, variolous  eruption  and  calcareous  arteries 


12       THE  HISTORY  OF  MEDICINE 

and  atheroma,  have  also  been  reported.  Pleurisy 
and  appendicitis  (Byzantine  period)  and  a  case  of 
true  gout  (sixth  century  A.D.)  belong  to  a  much 
later  time.  Bouchard's  nodes  (indicative  of  dilata- 
tion of  the  stomach),  the  enlarged  spleen  resulting 
from  malarial  infection,  mastoiditis,  and  infantile 
paralysis,  have  also  been  proved  to  have  occurred 
among  the  ancient  Egyptians. 

Ribs  of  date-palm  leaves  were  used  as  splints  in 
the  early  centuries  of  the  third  millennium,  and 
splints  of  the  same  material  are  still  in  use  in  the 
Egypt  of  to-day.  The  ancient  Nubian  remains 
exhibit  many  cases  of  fractures  that  had  been  per- 
fectly set  and  had  healed  satisfactorily.  Fractures 
of  the  ulna  near  the  wrist  (as  well  as  of  the  femur 
and  cranium)  are  quite  common.  These  injuries 
were  probably  sustained  in  attempting  to  ward  off 
the  blow  of  the  naboot.  This  weapon  was  a  staff, 
which  was  grasped,  by  the  person  wielding  it,  in 
both  hands.  Its  use  was  a  favorite  pastime  of  the 
ancient  Egyptians,  and  resembled  the  old  English 
quarterstaff  play.  Besides  the  injuries  caused  by 
the  naboot,  fatal  sword-cuts  of  the  skull  and  cranial 
ulcerations  from  carrying  water- jars  have  been 
noted. 

For  its  skill  in  medicine  Egypt  became  famous 
among  all  the  surrounding  nations.  The  Odyssey 
refers  to  it  as  a  land  producing  an  infinite  number  of 


THE  PRIEST-PHYSICIANS  13 

drugs,  where  each  physician  possessed  knowledge 
above  all  other  men.  Similarly  the  Hebrew  prophet 
Jeremiah  alludes  to  it  as  a  land  of  many  medicines. 
The  Greek  historian  Herodotus,  the  contemporary 
of  Hippocrates,  speaking  of  the  Egyptians  of  the 
fifth  century  B.C.,  says:  "Medicine  is  practiced 
among  them  on  a  plan  of  separation ;  each  physician 
treats  a  single  disorder,  and  no  more;  thus  the 
country  swarms  with  medical  practitioners,  some 
undertaking  to  cure  diseases  of  the  eye,  others  of 
the  head,  others  again  of  the  teeth,  others  of  the 
intestines,  and  some  those  which  are  not  local.'* 
He  also  takes  note  of  the  habits,  especially  among 
the  priestly  caste,  of  personal  hygiene,  light  cloth- 
ing, frequent  baths,  purgation,  and  careful  diet,  for 
they  have  a  persuasion  that  every  disease  to  which 
men  are  liable  is  occasioned  by  the .  substances 
whereon  they  feed. 

It  was  not  till  about  2100  B.C.  that  the  City  of 
Babylon,  under  the  leadership  of  Hammurabi,  a 
Semitic  (Amorite)  king,  gained  ascendancy  over  the 
Sumerian  cities,  which  lay  along  the  Tigris  and 
Euphrates  toward  the  Gulf  of  Persia.  In  the  ruins 
of  these  cities  has  been  discovered  the  record  of  a 
civilization  analogous  in  its  development  to  Egyp- 
tian civilization.  Long  before  3000  B.C.  the  Sume- 
rians  had  learned  how  to  control  the  freshets  of  the 
Euphrates  for  purposes  of  irrigation ;  they  cultivated 


14       THE  HISTORY  OF  MEDICINE 

barley  and  split  wheat,  reared  cattle,  sheep,  and 
goats,  made  use  of  the  ox  and  ass  in  ploughing  and 
transportation;  they  constructed  mud-brick  dwell- 
ings, as  well  as  enormous  stage-towers  as  places  of 
worship  and  sepulture;  they  had  ornaments  of  gold 
and  silver,  and  knives  of  copper  and  bronze;  they 
were  skilled  in  pottery  and  stone-cutting;  they 
developed  a  phonetic  system  of  writing  based  on  a 
primitive  pictorial  system,  for  it  was  to  these  early 
inhabitants  of  the  land  of  Shinar  that  the  East  was 
indebted  for  cuneiform  writing.  The  intellectual 
and  professional  life  of  the  Sumerians,  as  of  the 
Egyptians,  was  dominated  by  the  priestly  caste. 

The  Amorites  of  2100  B.C.  were  not  the  first  nor 
the  last  of  the  Semitic  races  to  overrun  the  cities 
and  adopt  the  system  of  writing  and  the  general 
culture  of  the  Sumerians.  Many  centuries  after 
Hammurabi,  the  Assyrians,  who  had  from  very 
early  times  felt  the  cultural  influence  of  the  Sumeri- 
ans, entered  upon  a  career  of  conquest,  and  from 
about  the  middle  of  the  eighth  till  near  the  close  of 
the  seventh  century  controlled  an  extensive  empire 
of  which  Babylonia  formed  a  part.  One  of  the  great 
Assyrian  kings,  Assurbanipal  (668-626  B.C.),  es- 
tablished in  his  palace  at  Nineveh  a  cuneiform 
library.  The  Code  of  Hammurabi,  a  collection  of 
laws  inscribed  on  a  large  block  of  black  diorite,  and 
the  clay  tablets  of  the  library  of  Assurbanipal  are 


THE  PRIEST-PHYSICIANS  15 

the  chief  sources  of  information  in  reference  to  what 
may  be  roughly  called  Babylonian  medicine. 

The  following  sections  from  this  earliest  code  of 
laws  known  to  history,  the  starting-point  of  medical 
jurisprudence,  throw  light  on  the  rights  and  duties 
of  the  surgeon  of  2080  B.C.  : 

"If  a  physician  operate  on  a  man  for  a  severe 
wound  (or  make  a  severe  wound  upon  a  man),  with 
a  bronze  lancet,  and  save  the  man's  life;  or  if  he 
open  an  abscess  (in  the  eye)  of  a  man,  with  a  bronze 
lancet,  and  save  that  man's  eye,  he  shall  receive  ten 
shekels  of  silver  (as  his  fee)." 

"  If  he  be  a  freeman,  he  shall  receive  five  shekels." 

"If  it  be  a  man's  slave,  the  owner  of  the  slave 
shall  give  two  shekels  of  silver  to  the  physician." 

"If  a  physician  operate  on  a  man  for  a  severe 
wound,  with  a  bronze  lancet,  and  cause  the  man's 
death;  or  open  an  abscess  (in  the  eye)  of  a  man, 
with  a  bronze  lancet,  and  destroy  the  man's  eye, 
they  shall  cut  off  his  hands." 

"If  a  physician  operate  on  a  slave  of  a  freeman 
for  a  severe  wound,  with  a  bronze  lancet,  and  cause 
his  death,  he  shall  restore  a  slave  of  equal  value." 

"  If  he  open  an  abscess  (in  his  eye),  with  a  bronze 
lancet,  and  destroy  his  eye,  he  shall  pay  silver  to 
the  extent  of  one  half  of  his  price." 


16       THE  HISTORY  OF  MEDICINE 

"If  a  physician  set  a  broken  bone  for  a  man,  or 
cure  his  diseased  bowels,  the  patient  shall  give  five 
shekels  of  silver  to  the  physician." 

"If  he  be  a  freeman,  he  shall  give  three  shekels." 

"If  it  be  a  man's  slave,  the  owner  of  the  slave 
shall  give  two  shekels  of  silver  to  the  physician." 

"If  a  veterinary  physician  operate  on  an  ox  or 
ass  for  a  severe  wound  and  save  its  life,  the  owner  of 
the  ox  or  ass  shall  give  to  the  physician,  as  his  fee, 
one  sixth  of  a  shekel  of  silver." 

"If  he  operate  on  an  ox  or  an  ass  for  a  severe 
wound,  and  cause  its  death,  he  shall  give  to  the 
owner  of  the  ox  or  ass  one  fourth  its  value." 

It  is  evident  that  in  this  translation  the  term 
"freeman"  indicates  a  rank  intermediate  between 
that  of  "man"  (or  gentleman)  and  that  of  "slave," 
and  that  the  term  "veterinary"  is  used  in  anticipa- 
tion, since  the  horse  was  unknown  in  Babylonia  till 
some  time  after  the  formulation  of  the  Code  of 
Hammurabi. 

As  already  implied,  the  medical  science  of  the 
Babylonians  was  closely  associated  with  their 
religious  beliefs  and  superstitions.  Disease  was 
considered  the  seizure  or  attack  of  the  patient  by 
some  demon  or  other,  such  as  the  demon  of  con- 
sumption, the  demon  of  liver  complaint,  and  the 


THE  PRIEST-PHYSICIANS  17 

particularly  hideous  demon  that  haunted  the  bed- 
side of  women.  Cures  were  to  be  effected  by  charms, 
incantations,  exorcisms,  and  other  magic  rites. 
These  led  to  the  use  of  remedies,  like  mint,  cassia, 
chicory,  sesame,  honey,  and  liquorice,  or  a  green 
frog,  the  foot  of  a  small  insect,  the  claw  of  a  black 
dog,  to  fortify  the  patient  and  to  drive  or  coax  out 
the  demon  of  disease.  As  the  Babylonian  priests 
sought  to  foretell  the  future  by  the  study  of  the 
heavens,  of  numbers,  and  of  geometrical  forms,  so 
they  turned  to  the  inspection  of  the  viscera  of 
sacrificial  animals  as  a  means  of  divination.  They 
believed,  like  the  Jews,  that  the  blood  was  the  vital 
principle,  in  some  sense  identical  with  the  soul; 
that  the  blood  was  elaborated  in  the  liver,  and  that 
consequently  that  organ  should  be  made  an  object 
of  particular  attention.  They  held  it  possible,  since 
the  deity  passed  into  all  animals  offered  up  in 
sacrifice,  to  read  the  disposition  of  the  divine  mind 
by  observing  the  markings  and  anomalies  of  a 
sheep's  liver.  Clay  models  of  this  organ,  dating 
from  about  2100  B.C.,  are  as  carefully  marked  off 
into  distinct  areas  as  our  modern  phrenological 
charts.  The  lobes,  ducts,  depressions,  fissures,  gall- 
bladder, etc.,  on  the  under  side  of  the  liver  were 
minutely  scrutinized  and  definitely  named.  Patho- 
logical conditions  were  especially  studied,  because 
all  irregularities  seemed  to  foretell  unusual  events. 


18       THE  HISTORY  OF  MEDICINE 

The  practice  of  inspecting  the  liver  for  purposes 
of  divination  —  hepatoscopy  -*-  passed  from  Baby- 
lonia as  far  west  as  Italy  and  was  not  without 
significance  in  the  development  of  anatomy  and 
physiology.  In  a  like  spirit  and  with  greater  results 
for  the  progress  of  science,  the  Babylonian  priests 
turned  their  attention  to  the  study  of  congenital 
abnormalities  in  man  and  animal,  and  to  the  inter- 
pretation of  pathological  symptoms.  A  monstros- 
ity was  an  evil  omen;  hysteria  and  epilepsy  and 
leprosy  were  special  marks  of  possession  or  of  divine 
condemnation.  In  the  study  of  birth-omens  and 
sickness-omens,  the  Babylonians  developed  a  knowl- 
edge of  the  various  parts  of  the  body,  and  learned 
to  recognize  the  symptoms  of  various  diseases. 
Among  the  latter  might  be  mentioned  as  finding 
a  place  in  cuneiform  medical  literature,  colds,  in- 
digestion, rheumatism,  neuralgia,  headache,  eye 
troubles,  heart  disease,  and  jaundice. 

Some  of  the  early  Babylonian  prescriptions  are 
half  exorcism  and  half  directions  for  effecting  a 
cure.  One  cuneiform  text,  for  example,  dictates  a 
formula  for  calling  down  the  wrath  of  the  god  Ea  on 
the  worm  that  causes  toothache,  but  advises  that 
while  the  curse  is  being  uttered  thrice,  the  aching 
tooth  should  be  treated  with  a  mixture  of  henbane 
and  resin.  Other  prescriptions  dispensed  altogether 
with  the  aid  of  magic:  "If  a  man  is  sick  of  a  cold, 


THE  PRIEST-PHYSICIANS  19 

which  has  turned  into  stomach  pains,  let  him  com- 
pound .  .  .  liquorice  root  .  .  .  these  seven  drugs  let 
him  drink  as  the  star  rises  and  in  the  morning 
without  food  [that  is,  evening  and  morning,  fasting], 
and  he  will  recover."  The  tendency  to  rely  less  and 
less  on  incantations  and  more  and  more  on  actual 
remedies  seems  to  have  been  more  pronounced  in 
the  later  stages  of  Babylonian  medicine.  Of  course, 
primitive  methods  were  resorted  to  in  desperate 
cases;  as,  for  example,  if  "a  man's  forehead  is 
affected  and  the  demon  in  a  man's  body  cries  out 
and  does  not  depart,"  the  traditional  treatments 
may  be  employed  as  a  last  resort.  Further  evidence 
of  the  progress  of  medicine  is  afforded  by  letters 
written  in  the  seventh  century  B.C.  to  Assurbanipal 
by  a  doctor  called  upon  to  treat  the  members  of 
the  royal  family  for  eye  trouble,  bleeding  of  the 
nose,  and  other  ailments.  They  read  like  the  com- 
munications of  a  rational,  sympathetic,  and  capable 
modern  practitioner.  One  of  these  sends  "Hearty 
greetings  to  the  little  chap  whose  eye  causes  him 
trouble"  and  gives  reasons  for  expecting  a  speedy 
recovery.  A  second  letter  with  similar  greetings  to 
the  king's  son  contains  excellent  directions  for 
arresting  persistent  haemorrhage  of  the  nose. 

In  the  textbook  literature  of  the  library  of  Assur- 
banipal are  found  long  lists  of  remedies,  which  are 
divided  into  two  classes  corresponding,  it  would 


20       THE  HISTORY  OF  MEDICINE 

seem  from  the  particular  Sumerian  words  used,  to 
the  distinction  of  organic  and  inorganic  substances. 
Among  the  latter  are  found  alkalies  and  salts,  as 
well  as  a  number  of  stones  which  had  probably  been 
thought  efficacious  as  amulets  before  taking  their 
place  in  the  pharmacopoeia.  Only  a  limited  number 
of  the  drugs  that  enter  into  cuneiform  prescriptions 
have  as  yet  been  identified,  but  in  addition  to  those 
already  set  down  the  following  might  be  mentioned ; 
anise,  cumin,  caraway,  colewort,  colocynth,  cori- 
ander, cynoglossum,  figs,  dates,  jasmine,  juniper, 
nard,  oleander,  willow,  and  sal  ammoniac.  Among 
the  therapeutic  agents  relied  on  by  the  Babylonian 
priest-physicians  are  found  purgatives,  diaphoretics, 
enemata,  compresses,  salves,,  poultices,  liniments, 
fumigations,  diet,  and  rest.  One  might  be  tempted 
to  ascribe  to  them  the  knowledge  of  a  form  of 
massage;  but  the  impression  must  not  be  created 
that  the  medical  science  of  the  Babylonians  ever 
attained  to  any  considerable  development.  At  its 
best  it  was  obscured  by  astrology  and  other  super- 
stitious beliefs,  and  at  no  time  completely  emerged 
from  the  primitive  stage.  By  the  fifth  century  B.C. 
it  seems,  indeed,  to  have  deteriorated;  for  according 
to  Herodotus  no  physicians  were  to  be  found  in  the 
Babylon  of  the  Persian  regime  and  patients  were 
brought  into  the  streets  to  receive  the  suggestions 
of  the  passers-by. 


THE  PRIEST-PHYSICIANS          21 

In  Babylonia  as  in  Egypt  the  conservatism  of  the 
priests  preserved  throughout  the  ages  the  medical 
knowledge  of  an  immemorial  past,  but  the  very 
quality  that  enabled  them  to  perpetuate  traditions 
prevented  their  making  any  marked  advance  to- 
ward a  real  medical  science.  Their  faith  in  the 
virtues  of  drugs  and  in  the  influence  of  the  stars 
was  detrimental  to  progress,  and  the  distinction  of 
making  the  first  great  contributions  to  scientific 
medicine  was  reserved  for  another  people,  among 
whom  the  healing  art  was  not  dominated  by  the 
priestly  caste. 

REFERENCES 

Finlayson,  James:  "Ancient  Egyptian  Medicine,"  British  Medical 
Journal,  1893,  vol.  I,  pp.  748,  1014,  1061. 

Harper,  R.  F. :  The  Code  of  Hammurabi.  Chicago,  1904. 

Holmes,  B.  T.,  and  Kitterman,  P.  G.:  Medicine  in  Ancient  Egypt. 
1914. 

Jastrow,  Morris,  Jr.:  (i)  "The  Medicine  of  the  Babylonians  and 
Assyrians,"  Proc.  Roy.  Soc.  Med.,  7*,  History  of  Med.  Sec- 
tion, 1913-14,  pp.  109-76. 

(2)  "  Babylonian-Assyrian  Medicine,  "Annals  of  Medical 
History,  vol.  i  (no.  3),  1917,  pp.  231-57. 

Joachim,  H.:  Papyros  Ebers.  1890.  (German  translation.) 

Moodie,  R.  L.:  "Studies  in  Paleopathology,"  Surg.  Clin.,  vol.  m, 
pp.  481-96.  Chicago,  1918. 

MQller,  VV.  Max:  Egyptological  Researches.  Carnegie  Institution, 
Washington,  1906. 

Ruffer,  Sir  M.  A.:  Studies  in  the  Paleopathology  of  Egypt.  Chi- 
cago, 1921. 

Ruffer,  Sir  M.  A.,  and  Ferguson,  A.  R.:  "Note  on  an  Eruption 
resembling  that  of  Variola  in  the  Skin  of  a  Mummy  of  the 
Twentieth  Dynasty,"  Journal  of  Path,  and  Bact.,  1910-11, 
vol.  15,  pp.  1-3. 


22       THE  HISTORY  OF  MEDICINE 

Shattock,  S.  G.:  "A  Report  upon  the  Pathological  Condition  of 
the  Aorta  of  King  Menephtah,  traditionally  regarded  as  the 
Pharaoh  of  the  Exodus,"  Proc.  Roy.  Soc.  Med.,  vol.  u, 
Pathological  Section,  1909,  pp.  122-27. 

Smith,  G.  Elliott,  and  Jones,  F.  Wood:  The  Archaeological  Survey 
of  Nubia,  Report  on  Human  Remains,  vol.  n.  Cairo,  1910. 


CHAPTER  II 
HIPPOCRATES  THE  FATHER  OF  MEDICINE 

THREE  great  extraneous  influences  contributed  to 
the  development  of  Greek  medicine  —  theology, 
philosophy,  and  athletics.  And  to  the  institutions 
through  which  these  influences  made  themselves 
felt,  namely,  the  temple,  the  school,  and  the  gym- 
nasium, Hippocrates  sustained  a  well-defined  rela- 
tion. 

Even  in  the  early  stage  of  Greek  culture  repre- 
sented in  the  Iliad  and  the  Odyssey  the  priesthood 
played  a  subordinate  part  in  the  healing  art.  These 
Homeric  poems,  to  be  sure,  speak  of  disease  as  due 
to  the  anger  of  the  gods,  and  tell  of  the  efforts  of 
the  priests  to  arrest  epidemics,  as  well  as  of  the 
recital  of  appropriate  incantations.  But  the  physi- 
cians, cunning  in  the  use  of  medicines,  are  evidently 
distinct  from  the  priests,  and  form  an  adjunct  of  the 
warrior  caste  rather  than  of  the  sacerdotal. 

In  the  Iliad,  ^Esculapius,  or  Asclepios,  is  a  Thes- 
salian  chief,  who  has  received  from  the  Centaur 
Chiron  instruction  in  the  use  of  drugs;  while  his 
two  sons  are  warriors  and  army  surgeons.  By  the 
beginning  of  the  eighth  century  B.C.,  tradition 
had  endowed  him  with  supernatural  powers.  He 


24       THE  HISTORY  OF  MEDICINE 

became  an  earth  god  —  especially  accessible  to  his 
votaries  in  sleep  —  and  was  portrayed  with  the 
snake  and  staff  and  other  attributes  of  such  a  deity. 
Not  long  after,  ^Esculapius  was  recognized  as  the 
god  of  medicine,  the  son  of  Apollo,  and  the  father, 
not  only  of  the  surgeon  Machaon  and  the  physician 
Podalirius,  but  of  a  younger  son,  Telesphorus,  the 
god  of  convalescence,  as  well  as  of  Hygeia  and 
Panacea.  Eventually  hundreds  of  temples  arose 
throughout  Hellas,  on  beautiful  and  salubrious 
sites  overlooking  the  sea  and  beside  healing  foun- 
tains, dedicated  to  the  worship  of  Asclepios.  Among 
the  most  famous  of  these  were  the  Asclepieia  of 
Epidaurus,  Cos,  Cnidus,  Crotona,  and  Pergamus. 

In  these  healthful  places,  the  strongholds  of 
miraculous  medicine,  the  priests  of  the  temples 
were  credited  with  cures  comparable  with  the  faith 
cures  duly  attested  to-day  at  Lourdes,  Sainte  Anne 
de  Beaupr£,  and  other  Christian  shrines.  In  the 
history  of  the  Greek  temples  there  are  some  indica- 
tions of  the  practice  of  fraud.  The  priests  of  JEscu- 
lapius  stirred  the  imaginations  and  played  upon  the 
superstitions  of  the  sufferers  by  sacrificial  rites  and 
purifications,  by  the  presence  of  tame  snakes,  con- 
tact with  which  brought  healing  by  the  power  of 
the  indwelling  god,  and,  in  the  third  place,  by  temple 
sleep  or  incubation.  The  suppliant,  lying  down  to 
sleep,  after  due  preparation,  by  the  altar  of  the  god, 


THE  FATHER  OF  MEDICINE        25 

was  at  times  granted  a  vision  of  ^Esculapius  himself, 
and  was  forthwith  healed.  Sometimes  the  priest 
condescended  to  impersonate  the  god,  offering 
equally  efficacious  treatment,  or  dictating  remedies. 
Again,  the  suppliant  might  be  permitted  to  dream 
by  proxy.  Those  that  were  benefited  by  the  sug- 
gestions, by  the  remedies,  or  by  the  restorative 
power  of  nature,  left  tablets  telling  of  their  cure,  or 
other  tokens,  such  as  models  of  the  healed  parts  in 
marble,  or  silver,  or  gold,  the  priests  taking  no 
pains  to  conceal  from  their  patients  the  therapeutic 
virtue  of  a  substantial  fee. 

Epidaurus,  as  befitted  the  reputed  birthplace  of 
^Esculapius,  was  one  of  the  loudest  of  the  temples 
in  proclaiming  the  benefits  of  divine  healing,  and 
upon  the  founding  of  a  new  temple  this  mother 
Asclepieion  sent  the  gift  of  a  snake,  symbolic  of  the 
god  of  medicine.  Two  pillars  inscribed  with  the 
record  of  faith  cures  have  been  recovered  on  the 
site  of  the  ancient  shrine.  The  following  translations 
will  indicate  how  the  temple  priests  sought  to  over- 
come the  skepticism  of  the  Greek  mind. 

"A  man  with  the  fingers  of  his  hand  paralysed, 
save  one.  He  came  a  suppliant  to  the  god,  and 
seeing  the  tablets  in  the  temple  he  disbelieved  the 
cures,  and  ridiculed  the  inscriptions,  and  sleeping 
he  saw  a  vision.  He  seemed  to  be  playing  dice,  and, 
as  he  was  about  to  throw,  the  god  appeared,  seized 


26       THE  HISTORY  OF  MEDICINE 

his  hand,  and  stretched  out  the  fingers,  then  he 
seemed  to  bend  them  up  and  stretch  them  out  one 
by  one,  and  when  all  were  straight  the  god  asked  if 
he  still  disbelieved  the  inscriptions  on  the  tablets, 
and  he  said  no.  Then  he  said:  'Fear  not  for  thy 
former  unbelief,  but,  that  thou  mayest  believe  in 
future,  thou  shalt  obtain  what  a  believer  obtains '(?) 
[the  sentence  is  much  mutilated].  And  when  it  was 
day  he  went  away  whole." 

"Ambrosia  of  Athens,  blind  of  one  eye.  She  came 
a  suppliant  to  the  god,  and  going  round  the  temple 
ridiculed  some  of  the  inscriptions,  saying  it  was 
incredible  and  impossible  that  the  lame  and  blind 
should  be  cured  by  seeing  a  dream- vision  only.  But 
having  slept  she  saw  a  vision;  the  god  seemed  to 
stand  by  her  and  say  that  he  would  heal  her,  but 
would  demand  "as  payment  a  silver  pig  to  be  set  up 
in  the  temple  as  a  memorial  of  her  stupidity.  Hav- 
ing thus  spoken  he  opened  her  diseased  eye  and 
poured  medicine  on  it,  and  when  it  was  day  she 
departed  cured." 

The  temple  priests  must  not  be  confused  with  the 
Asclepiads  (Asclepiadae),  often  in  attendance  at  the 
temples,  who  formed  a  guild  or  brotherhood  made  up, 
at  first,  of  physicians  claiming  descent  from  ^Escu- 
lapius.  At  some  of  the  temples  the  Asclepiads  no 
doubt  long  continued  to  connive  at  the  theurgy  and 
charlatanry  of  the  priests.  In  other  places,  however, 


THE  FATHER  OF  MEDICINE       27 

and  notably  at  Cnidus  and  Cos,  they  dissociated 
themselves  from  the  practice  of  mystic  healing  and 
taught  to  their  sons  and  disciples  medicine  as  based 
on  rational  principles. 

Among  the  philosophers  who  brought  the  influ- 
ence of  the  schools  to  bear  on  the  development  of 
early  Greek  medicine  Pythagoras,  Alcmaeon,  Em- 
pedocles,  and  Democritus  are  especially  prominent. 
Born  about  580  B.C.  on  the  island  of  Samos,  Py- 
thagoras traveled  extensively,  visiting  Egypt  and 
probably  Babylonia,  and  settled  at  Crotona  in 
South  Italy.  There  he  founded  a  sect  or  society 
which,  to  its  interest  in  mathematics,  ethics,  and 
other  branches  of  philosophy,  added  the  teaching 
and  practice  of  medicine  and  politics.  He  attended 
his  followers  when  they  were  sick,  and  advocated 
adherence  to  a  strict  diet.  In  the  Pythagorean 
school  there  developed  a  mystical  number  lore,  the 
elements  of  which  the  master  may  have  learned 
from  the  Egyptian  priests  or  the  Chaldean  astrol- 
ogers. It  is  difficult  to  comprehend  the  peculiar 
significance  this  philosophical  school  attached  to 
certain  numbers  and  number  relations.  For  ex- 
ample, four  was  of  interest  to  the  Pythagorean 
mind  as  the  square  of  the  first  even  number,  and 
still  more  so  as  symbolizing  the  perfection  of  eter- 
nally flowing  nature.  Ten  was  considered  a  perfect 
number.  Something  of  the  sentimental  value  asso- 


28       THE  HISTORY  OF  MEDICINE 

dated  with  particular  numbers  by  the  Pythagoreans, 
as  well  as  by  the  Babylonians  and  other  Eastern 
peoples,  still  lingers  in  the  attitude  of  the  imagina- 
tive to  the  sacred  number  three  and  the  mysterious 
number  seven.  The  number  lore  of  the  Pythago- 
reans is  important  for  us  because  it  later  conduced  to 
the  Hippocratic  doctrine  of  critical  days. 

Other  schools  of  philosophy  had  a  more  direct 
interest  in  medical  science.  Alcmseon  of  Crotona, 
philosopher  and  physician,  the  first  Greek  anato- 
mist, introduced  abdominal  section,  by  animal  dis- 
sections discovered  the  optic  nerve,  attempted  to 
explain  the  sense  of  hearing  and  the  sense  of  taste, 
and  recognized  the  brain  as  the  seat  of  mental 
activity.  Sleep  and  waking  are  due  to  the  ebb  and 
flow  of  the  blood,  death  to  its  cessation.  Health 
depends  on  the  harmony  of  the  material  elements 
of  the  body  —  cold,  warm,  moist,  dry,  bitter,  sweet. 
Empedocles  of  Agrigentum,  Sicily,  another  phil- 
osopher-physician, was  the  first  Greek  to  think  of 
the  universe  as  composed  of  four  elements. 

"Listen,  first,  while  I  sing  the  fourfold  root  of  creation, 
Fire,  and  water,  and  earth,  and  the  boundless  height  of  the  aether, 
For  therefrom  is  begotten  what  is,  what  was,  and  what  shall  be." 

Empedocles  is  said  to  have  freed  a  town  of  pestilence 
by  diverting  a  stream  and  draining  the  marshes  in 
its  vicinity,  and  to  have  improved  the  climate  of  his 
native  city  by  blocking  up  a  cleft  in  the  mountains. 


THE  FATHER  OF  MEDICINE       29 

Democritus,  a  contemporary  and  friend  of  Hippo- 
crates, studied  the  anatomy  of  animals  and  the 
physiology  of  reproduction  and  of  the  senses.  He 
taught  that  all  things  are  composed  of  an  infinite 
number  of  indivisible  particles,  or  atoms,  and  that 
the  impressions  made  upon  OHF  senses  are  the  source 
of  all  knowledge  and  of  all  thought. 

The  influence  of  athletics  on  the  development  of 
Greek  medicine  was  essentially  different  from  that 
of  philosophy.  The  gymnasts  were  the  devotees  of 
practice,  not  of  theory.  Through  experience  they 
acquired  skill  in  the  treatment  of  sprains,  disloca- 
tions, fractures,  and  other  injuries.  They  made  use 
of  inunctions  and  fomentations.  They  controlled 
the  weight  and  proportions  of  the  athletes  by 
means  of  purgation,  emesis,  massage,  steam  baths, 
exercise,  and  diet.  These  rude  empirics  were  con- 
sulted by  the  sick,  and  the  gymnast  Herodicus  of 
Selymbria,  with  whom  Hippocrates  came  into  con- 
tact, even  undertook  to  reduce  fever  by  methods 
borrowed  from  the  gymnasium.  Crotona,  as  fa- 
mous for  athletics  as  for  theurgy  and  philosophy, 
was  the  home  of  the  greatest  of  wrestlers,  Milo,  six 
times  crowned  victor  at  the  Olympian,  six  times  at 
the  Pythian,  games.  It  is  probable  that  Democedes 
of  Crotona,  the  first  regular  Greek  physician  of 
whose  life  we  have  an  account,  owed  some  of  his 
surgical  skill  to  the  gymnasium  of  his  native  city. 


30       THE  HISTORY  OF  MEDICINE 

Leaving  home  as  a  young  man,  Democedes  became 
public  physician  in  rapid  succession  at  ^Egina, 
Athens,  and  Samos,  his  salary  as  medical  officer 
mounting  from  $1200,  to  $2030,  to  $2800,  at  a  time 
when  the  incomes  of  officials  were  generally  very 
low,  and  the  purchasing  power  of  money  was  very 
high.  Later  he  found  himself  a  slave  at  the  court 
of  Darius,  whose  favor  he  gained  by  healing  a 
sprained  ankle,  which  had  baffled  the  efforts  of  the 
Egyptian  physicians  in  attendance  on  the  Persian 
king,  as  well  as  by  treating  the  queen  successfully 
for  abscess  of  the  breast.  The  one  boon  of  freedom 
was  withheld.  Finally,  however,  Darius  permitted 
Democedes  to  accompany  a  band  of  Persian  ex- 
plorers, the  Greek  undertaking  to  guide  them  in 
their  search  for  points  on  the  coast  of  Italy  most 
favorable  for  the  landing  of  a  Persian  army.  Ar- 
rived in  Calabria,  Democedes  delivered  his  com- 
panions into  the  hands  of  the  king  of  that  region. 
He  then  hastened  to  his  native  Crotona,  where, 
shortly  after,  he  married  the  beautiful  daughter  of 
Milo  the  athlete. 

The  three  influences  that  affected  Greek  medicine, 
namely,  the  theurgic,  the  theoretic,  and  the  em- 
piric, though  logically  distinct,  were  not  always 
separated  in  fact.  The  Pythagoreans  cultivated 
gymnastics  as  well  as  dietetics.  Milo  belonged  to 
the  political  faction  of  the  Pythagoreans  without 


THE  FATHER  OF  MEDICINE        31 

necessarily  sharing  their  enthusiasm  for  pure  mathe- 
matics and  an  abstemious  diet.  The  temple  priests, 
as  we  have  seen,  worked  at  times  in  conjunction 
with  the  temple  physicians,  and  there  is  evidence 
that  some  of  the  Asclepieia  were  provided  with 
gymnasiums,  in  which  tissue  change  was  effected 
by  exercise,  diet,  and  baths.  To  the  combined  in- 
fluence of  the  priests,  the  philosophers,  and  the 
gymnasts,  it  was  natural  that  the  genius  of  the 
greatest  physician,  bent  above  all  on  the  successful 
treatment  of  the  individual  patient,  should  in  some 
way  respond. 

Hippocrates  was  born  in  460  B.C.  at  Cos  on  the 
island  of  Cos.  His  father  and  grandfather  were  emi- 
nent physicians;  and  his  descent  has  been  traced 
on  the  paternal  side  to  ^Esculapius,  and  on  the 
maternal  side  to  Hercules.  He  received  his  first  in- 
struction in  the  medical  art  from  his  father,  and 
he  may  have  come  under  the  influence  of  the 
Asclepiads  of  the  neighboring  city  of  Cnidus,  as 
well  as  of  those  of  his  native  place.  He  traveled 
extensively,  practicing  and  teaching,  and  is  known 
to  have  visited  the  cities  of  Thrace,  Thessaly,  Asia 
Minor,  and  the  island  of  Thasus;  and  he  may  have 
been  acquainted  with  Athens,  then  at  the  height  of 
its  glory,  and  with  Scythia,  Egypt,  and  Libya.  He 
gave  instruction  at  the  school  of  the  Asclepiadae  of 
Cos  and  trained  his  sons  and  son-in-law  in  the  art. 


32       THE  HISTORY  OF  MEDICINE 

He  died  at  Larissa,  Thessaly,  at  a  very  advanced  age. 

An  early  Hippocratic  writing,  "The  Law," 
descriptive  of  the  education  of  an  ideal  physician, 
throws  light  on  the  training  of  Hippocrates.  "Who- 
ever is  to  acquire  a  competent  knowledge  of  medi- 
cine," it  says,  "ought  to  be  possessed  of  the  follow- 
ing advantages:  a  natural  disposition;  instruction; 
a  favorable  position  for  the  study;  early  tuition; 
love  of  labor;  leisure.  First  of  all,  a  natural  talent 
is  required;  for,  when  Nature  opposes,  everything 
else  is  vain ;  but  when  Nature  leads  the  way  to  what 
is  most  excellent,  instruction  in  the  art  takes  place, 
which  the  student  must  try  to  appropriate  to  him- 
self by  reflection,  becoming  an  early  pupil  in  a  place 
well  adapted  for  instruction.  He  must  also  bring 
to  the  task 'love  of  labor  and  perseverance,  so  that 
the  instruction  taking  root  may  bring  forth  proper 
and  abundant  fruits. 

"Instruction  in  medicine  is  like  the' culture  of  the 
productions  of  the  earth.  For  our  natural  disposi- 
tion is,  as  it  were,  the  soil ;  the  tenets  of  our  teachers, 
as  it  were,  the  seed ;  instruction  in  youth  is  like  the 
planting  of  the  seed  in  the  ground  at  the  proper 
season ;  the  place  where  the  instruction  is  communi- 
cated is  like  the  nourishment  imparted  to  plants  by 
the  atmosphere;  diligent  study  is  like  the  cultiva- 
tion 'of  the  fields;  and  it  is  time  which  imparts 
strength  to  all  things  and  brings  them  to  maturity." 


HIPPOCRATES 
The  Bust  in  the  British  Museum 


THE  FATHER  OF  MEDICINE       33 

The  ancient  Oath  of  the  Asclepiads  of  Cos,  also 
known  to  have  been  written  before  the  time  of 
Hippocrates,  indicates  the  source  of  his  professional 
ethics: 

THE  OATH 

"I  swear  by  Apollo  the  physician,  and  JEscu- 
lapius,  and  Hygeia,  and  Panacea,  and  all  the  gods 
and  goddesses,  that,  according  to  my  ability  and 
judgment,  I  will  keep  this  Oath  and  this  stipulation 
—  to  reckon  him  who  taught  me  this  Art  equally 
dear  to  me  as  my  parents,  to  share  my  substance 
with  him,  and  relieve  his  necessities  if  required;  to 
look  upon  his  offspring  in  the  same  light  as  my  own 
brothers,  and  to  teach  them  this  Art,  if  they  should 
wish  to  learn  it,  without  fee  or  stipulation ;  and  that 
by  precept,  discourse,  and  every  other  mode  of  in- 
struction, I  will  impart  a  knowledge  of  the  Art 
to  my  own  sons,  and  those  of  my  teachers,  and  to 
disciples  bound  by  a  stipulation  and  oath  according 
to  the  law  of  medicine,  but  to  none  others.  I  will 
follow  that  system  of  regimen  which,  according  to 
my  ability  and  judgment,  I  consider  for  the  benefit 
of  my  patients,  and  abstain  from  whatever  is 
deleterious  and  mischievous.  I  will  give  no  deadly 
medicine  to  any  one  if  asked,  nor  suggest  any  such 
counsel;  and  in  like  manner  I  will  not  give  to  a 
woman  a  pessary  to  produce  abortion.  With  purity 
and  with  holiness  I  will  pass  my  life  and  practice  my 


34       THE  HISTORY  OF  MEDICINE 

Art.  I  will  not  cut  persons  laboring  under  the  stone, 
but  will  leave  this  to  be  done  by  men  who  are 
practitioners  of  this  work.  Into  whatever  houses  I 
enter,  I  will  go  into  them  for  the  benefit  of  the  sick, 
and  will  abstain  from  every  voluntary  act  of  mis- 
chief and  corruption;  and  further,  from  the  seduc- 
tion of  females  or  males,  of  freemen  and  slaves. 
Whatever,  in  connection  with  my  professional  prac- 
tice, or  not  in  connection  with  it,  I  see  or  hear,  in 
the  life  of  men,  which  ought  not  to  be  spoken  of 
abroad,  I  will  not  divulge,  as  reckoning  that  all  such 
should  be  kept  secret.  While  I  continue  to  keep  this 
Oath  unviolated,  may  it  be  granted  to  me  to  enjoy 
life  and  the  practice  of  the  Art,  respected  by  all 
men,  in  all  times!  But  should  I  trespass  and  violate 
this  Oath,  may  the  reverse  be  my  lotj" 

The  tendency  shown  in  the  Oath  to  substitute 
benevolence,  social  duty,  and  moral  law  for  religious 
superstition  is  no  less  marked  in  the  writings  of 
Hippocrates,  the  contemporary  of  Socrates.  In  his 
treatise  "On  Airs,  Water,  and  Localities, "  which 
deals  with  disease  in  relation  to  geographical  and 
meteorological  conditions,  or  constitutions,  Hippo- 
crates states  that  the  Scythians  attribute  the  pre- 
mature impotence  of  some  of  their  men  to  a  god,  but 
that  it  appears  to  him  that  such  affections  are  just 
as  much  divine  as  all  others  are,  and  that  no  one 
disease  is  either  more  divine  or  more  human  than 


THE  FATHER  OF  MEDICINE       35 

another,  but  that  all  are  alike  divine,  for  each  has 
its  own  nature,  and  that  no  one  arises  without  a 
natural  cause.  The  Hippocratic  writing  "On  the 
Sacred  Disease,"  written  by  some  Huxley  among 
the  disciples  of  the  master,  deals  exclusively  with 
the  claim  of  epilepsy  to  be  considered  divine  in  its 
origin.  If  diseases  are  to  be  called  divine  because 
they  are  wonderful  and  ill  understood,  then  the 
quotidian,  tertian,  and  quartan  fevers  seem  to  the 
author  of  the  treatise  no  less  sacred  and  divine  in 
their  origin  than  epilepsy.  Those  who  first  referred 
the  latter  disease  to  the  gods  were  probably  just 
such  people  as  the  conjurors,  purificators,  mounte- 
banks, and  charlatans  of  his  own  time.  These  give 
themselves  out,  the  treatise  proceeds,  to  be  ex- 
tremely religious,  but  it  is  no  homage  to  the  gods  to 
see  their  manifestation  in  the  symptoms  of  epilepsy 
—  outcries,  gnashing  of  the  teeth,  foaming  at  the 
mouth,  contortions,  kicking,  fever,  delirium,  fear, 
and  flight.  Then,  if  the  epileptics  be  divinely 
possessed,  why  must  they  be  submitted  to  purifica- 
tion? They  should  rather  be  taken  to  the  temple  and 
presented  to  the  god,  if  a  god  be  the  cause  of  the 
disease.  However,  in  spite  of  this  vehement  con- 
troversy, we  must  not  think  of  Hippocrates  and  his 
followers  as  atheists.  While  protesting  against  an 
unworthy  conception  of  divinity,  they  respected 
the  traditions,  inculcated  lofty  ideals  of  profes- 


36      THE  HISTORY  OF  MEDICINE 

sional  conduct,  dignity  of  deportment,  respect  for 
patients,  devotion  to  universal  charity  and  to 
medicine.  For,  as  they  declared,  where  love  of  man- 
kind is,  there  is  also  love  of  the  Art. 

The  Hippocratic  respect  for  tradition  led,  at  the 
same  time,  to  a  just  appreciation  of  the  teaching  of 
the  gymnasium,  much  of  it  inherited,  no  doubt, 
from  the  remote  past.  The  writings  of  Hippocrates 
"On  Fractures"  and  "On  Dislocations,"  which  have 
been  described  (by  Malgaigne)  as  the  ablest  works 
ever  written  by  a  physician,  as  well  as  his  treatise 
"On  Injuries  of  the  Head,"  and  his  other  surgical 
works,  reflect  the  skill  and  wisdom  resulting  from 
long  experience.  He  was  bold  in  the  use  of  the 
trephine  and  raspatory,  employed  ink  and  pitch 
in  the  manner  of  the  Egyptians,  insisted  on  the 
necessity  of  cleanliness  and  dryness  in  the  handling 
of  fresh  wounds,  mentioned  healing  by  first  inten- 
tion, referred  to  exfoliation  of  the  bone,  and  to  the 
dangers  of  erysipelas,  tetanus,  and  gangrene,  noted 
the  occurrence  of  fracture  by  contre-coup  and  of 
paralysis  of  the  opposite  side  in  cases  of  lesions 
of  the  brain,  described  the  treatment  of  compound 
fractures,  as  well  as  various  methods  of  bandaging 
and  of  reduction  with  and  without  apparatus.  In 
his  "Aphorisms"  Hippocrates  remarks  that  it  is 
not  well  for  athletes  to  develop  tissue  to  the  utmost 
limit.  Once  arrived  at  the  maximum,  it  is  impossible 


THE  FATHER  OF  MEDICINE       37 

to  improve  or  to  remain  stationary.  Instead  of 
slowly  deteriorating,  it  is  well  to  reduce  rapidly  in 
order  to  begin  again  the  process  of  repair.  It  is 
dangerous,  however,  to  carry  methods  of  reduction 
to  extremes.  In  like  manner,  medicinal  evacuations, 
if  carried  to  an  extreme,  are  dangerous;  and,  also, 
a  restorative  course,  if  in  the  extreme,  is  dangerous. 
A  slender  and  restricted  diet  is  always  dangerous  in 
chronic  diseases,  and  also  in  acute  diseases,  where 
it  is  not  requisite.  Again,  as  diet  brought  to  the 
extreme  point  of  attenuation  is  dangerous,  repletion, 
when  in  the  extreme,  is  likewise  dangerous. 

The  Hippocratic  book  "On  Ancient  Medicine," 
which  ingeniously  traces  the  origin  of  the  Art  to  the 
practical  study  of  diet  carried  on  by  man  from  the 
remotest  past,  suggests  to  the  physician  that  ad- 
vances are  still  to  be  made  by  continuing  the  study 
with  full  knowledge  of  what  has  already  been 
achieved.  "Wherefore  those  who  devote  themselves 
to  gymnastics  and  training  are  always  making  some 
new  discovery  by  pursuing  the  same  line  of  inquiry, 
where,  by  eating  and  drinking  certain  things,  they 
improve  and  grow  stronger  than  they  were."  What 
must  be  said  of  those  who  prosecute  their  inquiries 
in  the  Art  by  hypothesis  rather  than  by  the  ancient 
method  of  trial?  The  former  procedure  has  its 
difficulties.  "  For  if  hot,  or  cold,  or  moist,  or  dry,  be 
that  which  proves  injurious  to  man,  and  if  th^per- 


38       THE  HISTORY  OF  MEDICINE 

son  who  would  treat  him  properly  must  apply  cold 
to  the  hot,  hot  to  the  cold,  moist  to  the  dry,  and  dry 
to  the  moist  —  let  me  be  presented  with  a  man,  not 
indeed  one  of  a  strong  constitution,  but  one  of  the 
weaker,  and  let  him  eat  wheat,  such  as  it  is  supplied 
from  the  thrashing-floor,  raw  and  unprepared,  with 
raw  meat,  and  let  him  drink  water.  By  using  such  a 
diet  I  know  that  he  will  suffer  much  and  severely, 
for  he  will  experience  pains,  his  body  will  become 
weak,  and  his  bowels  deranged,  and  he  will  not 
subsist  long.  What  remedy,  then,  is  to  be  provided 
for  one  so  situated?  Hot?  or  cold?  or  moist?  or 
dry?"  Thus  the  treatise  "On  Ancient  Medicine" 
passes  from  a  consideration  of  the  empirics,  con- 
demned by  Hippocrates  only  when  they  went  be- 
yond their  proper  sphere,  to  a  criticism  of  the 
theorists,  or  philosophers. 

It  has  frequently  been  said  that  Hippocrates,  in 
addition  to  repudiating  the  supernatural  as  a  cause 
of  disease,  was  the  first  to  separate  medicine  from 
philosophy.  That  is  indeed  true  if  philosophy  be 
identified  with  vain  speculation.  For  the  fantastic 
conjectures  of  Pythagoras  and  Empedocles,  Hip- 
pocrates and  his  followers  substituted  a  common- 
sense  philosophy,  still  potent  in  our  own  time. 
They  held  that  all  general  views  of  the  nature  of 
disease  must  rest  on  practice  and  the  use  of  reason. 
All  valid  thinking  is  based  on  the  data  supplied  by 


THE  FATHER  OF  MEDICINE       39 

the  senses,  the  understanding  giving  meaning  to 
these  phenomena,  noting  the  manner  of  their  oc- 
currence, their  times,  and  the  relation  between 
them  of  cause  and  effect.  Conclusions  must  be 
grounded  in  observation.  The  physician  should, 
therefore,  hold  to  facts,  so  as  to  acquire  mastery 
in  the  medical  Art.  "  Theory  is  the  flower,  not  the 
root  of  experience."  The  famous  opening  sentences 
of  the  "Aphorisms"  attest  the  power  of  a  philo- 
sophic mind  to  rise  to  general  conceptions,  while 
still  mindful  of  the  observations  and  practice  from 
which  they  were  developed.  "Life  is  short,  and  the 
Art  long;  the  time  is  urgent;  experiment  is  danger- 
ous, and  decision  is  difficult.  The  physician  must 
not  only  be  prepared  to  do  what  is  right  himself, 
but  also  to  make  the  patient,  the  attendants,  and 
externals  cooperate." 

Diagnosis  furnished  a  solid  basis  for  his  generaliza- 
tions. He  observed  the  color  and  general  state  of 
the  skin  and  mucous  surfaces,  the  eyes,  the  facial 
expression,  the  movements  of  the  body,  the  quantity 
and  nature  of  the  dejecta  and  various  secretions, 
the  temperature,  and,  to  some  extent,  the  pulse, 
respiration,  rash,  spasm,  sore  throat,  chills  and 
fever,  localized  pains,  headache,  tenesmus,  thirst, 
appetite,  nausea,  vertigo,  lassitude,  deafness,  dis- 
ordered vision,  fear,  loquacity,  delirium,  coma, 
plucking  at  the  bedclothes.  He  noted  the  distension 


40       THE  HISTORY  OF  MEDICINE 

of  the  abdomen,  and  by  palpation  determined  the 
enlargement  of  the  liver  or  the  spleen.  He  took 
account  of  the  form  of  the  chest,  the  character  of 
the  voice,  and,  employing  succussion  and  ausculta- 
tion, detected  the  signs  of  pneumohydrothorax  or 
of  pleuritic  friction.  Not  content  with  the  mere 
determination  of  symptoms,  Hippocrates  has  left 
us  ("Epidemics,"  Books  I  and  in)  forty-two  case 
histories,  which  remained  without  parallel  in  the 
history  of  medicine  for  about  two  thousand  years. 
The  following  is  one  of  the  briefest  in  the  collection : 

"Criton,  in  Thasus,  while  still  on  foot,  and  going 
about,  was  seized  with  a  violent  pain  in  the  great 
toe;  he  took  to  bed  the  same  day,  had  rigors  and 
nausea,  recovered  his  heat  slightly,  at  night  was 
delirious.  On  the  second,  swelling  of  the  whole  foot, 
and  about  the  ankle  erythema,  with  distension,  and 
small  bullae  (phlyctaense) ;  acute  fever;  he  became 
furiously  deranged;  alvine  discharges  bilious,  un- 
mixed, and  rather  frequent.  He  died  on  the  second 
day  from  the  commencement." 

Hippocrates  did  not  rest  satisfied  with  the  record 
of  individual  cases  and  their  symptoms.  In  his 
treatise  "On  Regimen  in  Acute  Diseases"  he  ad- 
mits that  the  Asclepiads  of  Cnidus  had  described 
accurately  the  symptoms  of  various  diseases,  and 
even  how  certain  of  them  terminate;  but  they  had 
unduly  multiplied  species.  The  physician  should 


THE  FATHER  OF  MEDICINE        41 

not  make  the  number  of  species  of  disease  as  great 
as  that  of  their  manifestations.  In  another  treatise 
("Prognostics")  the  Father  of  Medicine  urges  upon 
the  physician  the  need  of  so  knowing  the  various 
diseases  in  their  specific  tendencies  and  in  their 
relation  to  the  constitution  of  the  individual  patient 
as  to  be  able  to  foretell  their  course  and  outcome. 
"He  should  observe  thus  in  acute  diseases:  first, 
the  countenance  of  the  patient,  if  it  be  like  the 
countenances  of  persons  in  health,  and  more  so,  if 
like  itself,  for  this  is  the  best  of  all;  whereas  the 
most  opposite  to  it  is  the  worst,  such  as  the  following: 
a  sharp  nose,  hollow  eyes,  collapsed  temples;  the 
ears  cold,  contracted,  and  their  lobes  turned  out; 
the  skin  about  the  forehead  being  rough,  distended 
and  parched ;  the  color  of  the  whole  face  being  green, 
black,  livid,  or  lead-colored."  This  is  the  fades 
Hippocratica,  indicative  of  approaching  dissolution. 
We  are,  of  course,  indebted  to  Hippocrates  for  the 
terms  acute,  chronic,  endemic,  epidemic,  in  their 
application  to  disease,  for  the  recognition  of  the 
tuberculous  nature  of  Pott's  disease,  for  the  de- 
scription of  the  peculiar  respiration  "like  that  of  a 
person  recollecting  himself,"  for  clinical  pictures  of 
various  diseases,  including  puerperal,  intermittent 
and  remittent  fevers ;  the  latter  especially  interesting 
since  the  decline  of  Hellenic  civilization  may  have 
been  owing  to  the  ravages  of  malaria.  But  a  few 


42       THE  HISTORY  OF  MEDICINE 

quotations  from  the  "Aphorisms"  will  show  that, 
true  to  his  own  teaching,  he  advanced  to  a  knowl- 
edge of  diseases  in  their  tendencies  and  outcome. 
"  Those  cases  of  epilepsy  which  come  on  before 
puberty  may  undergo  a  change;  but  those  which 
come  on  after  twenty-five  years  of  age,  for  the  most 
part  terminate  in  death"  (v,  7).  "Phthisis  most 
commonly  occurs  between  the  age  of  eighteen  and 
thirty-five  years"  (v,  9).  "When  sleep  puts  an  end 
to  delirium,  it  is  a  good  symptom"  (u,  2).  In  the 
same  spirit  of  generalization  he  says:  "An  article 
of  food  or  drink  which  is  slightly  worse,  but  more 
palatable,  is  to  be  preferred  to  such  as  are  better, 
but  less  palatable"  (u,  38).  "Acute  diseases  come 
to  a  crisis  in  fourteen  days"  (n,  23).  "A  true 
tertian  comes  to  a  crisis  in  seven  periods  at  the 
furthest"  (iv,  59). 

As  already  implied,  a  trace  of  Pythagorean  doctrine 
can  be  detected  in  the  Hippocratic  theory  of  critical 
days.  And  a  like  concession  to  the  four  elements  of 
Empedocles  is  noticeable  in  the  doctrine  of  the  four 
humors.  According  to  this  teaching,  for  the  origin 
and  complete  development  of  which  Hippocrates 
was  not  responsible,  blood  is  hot  and  moist  like  air, 
phlegm  is  cold  and  moist  like  water,  yellow  bile  is 
hot  and  dry  like  fire,  and  black  bile  is  cold  and  dry 
like  earth.  As  one  or  other  of  these  humors  pre- 
dominated in  an  individual,  he  was  supposed  to  be 


THE  FATHER  OF  MEDICINE       43 

of  a  sanguine,  phlegmatic,  choleric,  or  melancholy 
temperament.  This  view,  which  persists  in  scientific 
and  general  literature  even  to  the  present  time,  may 
be  illustrated  from  Shakespeare's  "Julius  Caesar," 
in  which  play  the  sanguine  Antony,  the  phlegmatic 
Octavius,  the  choleric  Cassius,  and  the  melancholy 
Brutus  represent  the  four  temperamental  types, 
while  the  ideal  character  is  that  in  which  the  four 
humors  are  naturally  and  harmoniously  mingled. 
Similarly  in  the  Hippocratic  physiology,  health 
depended  on  the  crasis,  or  blending,  of  the  four 
juices  of  the  body.  Unless  they  duly  blend,  there  is  a 
state  of  dyscrasia,  or  crudity,  the  humors,  like  raw 
food,  acting  as  irritants.  Health  must  be  restored 
by  a  process  of  coction  (or  pepsis)  wherein  the  in- 
ternal heat  of  the  body  cooks  the  crude  humors. 
Upon  this  follows  a  crisis  —  a  separation,  or  elimi- 
nation —  of  the  superfluous  substance.  The  ele- 
ments may  be  restored  to  a  state  of  harmony  and 
equilibrium  by  the  remedial  power  of  Nature.  It 
was  faith  in  this  vis  medicatrix  natures  which  led 
Hippocrates  to  adopt  an  expectant  attitude  in  the 
treatment  of  many  of  his  cases,  to  abstain  at  times 
from  surgical  interference,  and  to  prescribe  drugs 
and  cooling  drinks  as  auxiliaries  of  Nature  in  the 
expulsion  of  the  morbific  matter  after  a  fever 
crisis. 

However  it  may  have  been  with  his  followers, 


44       THE  HISTORY  OF  MEDICINE 

Hippocrates  was  carried  away  by  no  doctrine  or 
theory.  Seeing  the  particular  in  the  general  and  the 
general  in  the  particular,  he  bent  his  comprehensive 
genius  to  the  healing  of  the  individual  patient. 
Plato  justly  compared  him  to  the  Athenian  sculptor 
Phidias,  who  beheld  the  ideal  in  the  real  and  im- 
pressed upon  the  rocks  of  Pentelicus  the  stamp  of 
an  eternal  beauty.  To  enjoy  the  practice  of  the  Art, 
to  serve  as  a  model  for  all  true  physicians,  to  be 
respected  and  honored  by  all  men  in  all  times,  was 
and  is  the  reward  and  destiny  of  the  greatest  of  the 
Asclepiads. 

REFERENCES 

Adams,  Francis:  The  Genuine  Works  of  Hippocrates.  2  vols., 
London,  1849,  872  pp.  (pagination  continuous). 

Allbutt,  (Sir)  T.  C:  "Essay  on  the  Medicine  of  the  Greeks," 
Medical-Chirurgical  Review,  vol.  xxxvin,  pp.  483-98.  Lon- 
don, 1866. 

Caton,  Richard:  "Hippocrates  and  the  newly-discovered  Health 
Temple  of  Cos,"  British  Medical  Journal,  1906, 1,  pp.  571-74. 
(It  is  illustrated,  and  alludes  to  the  supposed  connection 
between  the  worship  of  ^Esculapius  and  the  worship  of 
Imhotep.) 

Clifton,  Francis:  Hippocrates  upon  Air,  Water,  and  Situation,  etc. 
London,  1734.  389  pp. 

Finlayson,  James:  "Hippocrates,"  Glasgow  Medical  Journal, 
vol.  xxxvn,  pp.  253-71.  1892.  (Excellent  review  of  the 
sources.) 

Jones,  W.  H.  S.:  Malaria,  a  Neglected  Factor  in  the  History  of 
Greece  and  Rome.  With  Introduction  by  Major  (Sir)  R.  Ross, 
and  a  concluding  chapter  by  G.  G.  Ellett.  Cambridge,  1907. 
107  pp. 

Jones,  W.  H.  S. :  Malaria  and  Greek  History,  to  which  is  added  the 
History  of  Greek  Therapeutics  and  the  Malaria  Theory,  by 


THE  FATHER  OF  MEDICINE       45 

E.  T.  Withington.  Manchester,  The  University  Press,  1909. 

175  PP- 

Withington,  E.  T.:  "  The  Asclepiadae  and  the  Priests  of  Ascle- 
pius,"  Studies  in  the  History  and  Method  of  Science,  second 
series,  edited  by  Charles  Singer,  pp.  191-205.  Clarendon 
Press,  1921. 


CHAPTER  III 
ROMAN  ANATOMY  AND  SURGERY 

THAT  study  of  anatomy  and  practice  of  surgery 
which  within  the  bounds  of  the  Roman  Empire 
reached  their  culmination  in  the  first  and  second 
centuries  of  the  Christian  era  can  be  traced  in  their 
development  from  the  medical  science  of  the  age 
of  Hippocrates.  Diocles  of  Carystus,  who  stood 
next  to  the  sage  of  Cos  in  age  and  distinction,  was  a 
dissector  of  animals,  and  in  a  work  on  zootomy 
described  the  heart,  the  large  blood-vessels,  and  a 
greater  number  of  the  smaller  vessels  than  had  been 
recognized  in  earlier  works.  He  agreed  with  his 
contemporary  Plato,  as  well  as  one  of  the  less 
authentic  Hippocratic  writings  ("On  the  Heart"), 
in  looking  upon  the  heart  as  the  source  that  sent 
its  streams  to  all  parts  of  the  body.  Diocles  knew 
the  oesophagus,  the  biliary  ducts,  the  caecum,  the 
ureters,  and  the  Fallopian  tubes.  He  was  the  in- 
ventor of  a  bandage  for  the  head,  and  of  the  graph- 
iscus,  a  spoon-like  instrument  later  used  in  the 
Roman  armies  to  extract  arrows  and  spears  from 
wounds.  He  made  use  of  opium  as  an  anodyne,  and 
distinguished  pleurisy  from  pneumonia.  Praxag- 
oras  of  Cos  was  the  first  to  differentiate  veins  and 


ROMAN  ANATOMY  AND  SURGERY    47 

arteries,  the  former  filled  with  blood,  the  latter  with 
vital  air,  or  pneuma.  He  recorded  the  local  condi- 
tions of  pleurisy,  was  the  first  among  the  Greeks  to 
recognize  the  importance  of  the  pulse  in  diagnosis, 
and  advised  laparotomy,  as  a  last  resort,  in  in- 
testinal obstruction,  though  there  is  no  evidence 
that  this  operation  was  actually  put  in  practice  in 
his  age.  Diocles  and  Praxagoras  are  classed  among 
the  Dogmatists,  who  were  under  the  influence  of 
medical  speculations  concerning  the  pneuma  (which 
in  the  opinion  of  Diocles  was  renewed  by  respira- 
tion) and  concerning  the  four  humors.  For  example, 
both  Diocles  and  Praxagoras  attributed  epilepsy  to 
a  derangement  of  the  humors,  as  did  also  the  specu- 
lative philosopher  Plato  and  the  author  of  "On  the 
Sacred  Disease,"  who  was  more  successful  in  stating 
what  is  not  than  what  is  the  cause  of  that  malady. 
Aristotle  of  Stagira,  the  son  of  the  Asclepiad 
Nicomachus  and  the  pupil  of  Plato,  laid  the  founda- 
tions of  comparative  anatomy  by  dissecting  about 
fifty  species  of  animals,  including  the  deer,  elephant, 
horse,  ox,  pig,  domestic  fowl,  chamaeleon  (which  had 
been  made  a  special  study  by  Democritus),  tortoise, 
frog,  sepia,  crab,  lobster,  murex,  and  sea-urchin. 
He  carried  into  his  investigations  the  experimental 
spirit,  which,  contrary  to  the  teachings  of  many 
historians,  was  never  wanting  in  the  medical  science 
of  antiquity.  He  vivisected  some  of  the  lower  ani- 


48       THE  HISTORY  OF  MEDICINE 

mals,  discovered  that  the  tails  of  saurians  would 
grow  again  after  being  cut  off,  that  the  chamseleon 
would  continue  to  breathe  for  a  considerable  time 
after  being  cut  open  along  its  entire  length,  and  he 
referred  to  the  movements  of  the  heart  of  the 
tortoise  after  the  organ  had  been  excised.  Aristotle 
must  be  credited  with  a  knowledge  of  the  rudiments 
of  histology,  as  he  recognized  the  various  tissues  — 
bone,  blood,  fat,  skin,  cartilage,  hair,  connective 
tissue,  and  so  forth.  He  studied  the  embryos  of 
various  animals,  observed  the  early  appearance  of 
the  chick's  heart,  its  brain  and  eyes,  the  rapid 
growth  of  the  allantois  from  the  fifth  day  of  incuba- 
tion, and  the  allantoic  and  vitelline  blood-vessels 
on  the  sixth.  He  was  well  acquainted  in  the  adult 
with  the  liver,  spleen,  jejunum,  colon,  sigmoid 
flexure,  rectum,  the  trachea,  the  brain  membranes 
and  the  network  of  blood-vessels  covering  the  brain, 
the  structure  of  the  lungs  and  the  richness  of  their 
blood  supply.  Perhaps  his  greatest  single  contribu- 
tion was  his  study  of  the  heart  with  its  chordae 
tendinese,  and  his  attempt  to  describe  the  arrange- 
ment of  the  blood-vessels,  especially  the  branches 
of  the  aorta,  as  that  vessel  is  called  in  the  writings 
of  this  father  of  science.  A  brief  quotation  from  the 
"Historia  Animalium"  will  serve  as  an  example  of 
the  many  passages  in  which  Aristotle  anticipated 
the  investigations  of  modern  scientists.  "The  ear," 


ROMAN  ANATOMY  AND  SURGERY  49 

he  says,  "is  constructed  internally  like  the  trumpet- 
shell,  and  the  innermost  bone  is  like  the  ear  itself, 
and  into  it  at  the  end  the  sound  makes  its  way,  as 
into  the  bottom  of  a  jar.  This  receptacle  does  not 
communicate  by  any  passage  with  the  brain,  but 
does  so  with  the  palate,  and  a  vein  extends  from  the 
brain  towards  it."  He  failed  to  understand  the 
function  of  the  nerves  that  lay  before  him,  and  em- 
ployed the  word  neuron  to  indicate  the  material  of 
the  tendons,  ligaments,  and  of  the  fibrin  of  the 
blood. 

Luckily  the  structure  and  functions  of  the  nerves 
and  brain  were  to  a  considerable  extent  elucidated 
by  the  investigations  of  Herophilus  and  Erasistratus 
at  the  beginning  of  the  third  century  B.C.  They 
were  enabled  to  carry  on  their  investigations  at 
Alexandria  through  the  patronage  of  the  Greek 
kings  of  Egypt,  Ptolemy  Soter  and  Ptolemy  Phila- 
delphus,  who  placed  at  their  disposal  the  bodies  of 
condemned  criminals  for  experiment  and  dissection. 
Herophilus  studied  the  membranes  of  the  brain,  the 
sinuses  of  the  dura  mater,  and  noted  the  dilatation 
of  the  superior  longitudinal  sinus  now  known  as  the 
wine-press  of  Herophilus  (torcular  Herophili).  He 
examined  carefully  the  ventricles  of  the  brain  with 
their  choroid  plexuses,  especially  the  fourth  ventri- 
cle, or  ventricle  of  the  cerebellum,  which  he  con- 
sidered as  the  seat  of  intelligence,  and  gave  the 


50       THE  HISTORY  OF  MEDICINE 

furrow  at  the  floor  of  the  ventricle  a  name  corre- 
sponding to  the  Latin  calamus  scriptorius.  Hero- 
philus  also  traced  a  number  of  the  nerves  to  their 
connection  with  the  brain  and  cord,  and  recognized 
their  function  as  transmitters  of  will  and  sensation. 
Erasistratus,  in  turn,  compared  the  convolutions 
of  the  cerebrum  to  the  folds  of  the  jejunum,  noted 
their  greater  complexity  in  man  than  in  the  lower 
animals,  and  ascribed  the  difference  in  complexity 
to  difference  of  mental  development.  He  agreed 
with  Herophilus  in  regarding  the  cerebellum  as  the 
special  seat  of  intelligence,  and  remarked  that  the 
structure  of  this  part  of  the  brain  differs  from  that 
of  the  cerebrum.  Erasistratus  further  agreed  with 
Herophilus  in  dividing  nerves  into  nerves  of  move- 
ment and  nerves  of  sensation.  He  also  taught  that 
the  nerves  arise  from  the  brain  substance  and  are 
filled  with  marrow. 

Herophilus  contributed  to  other  departments  of 
anatomy.  He  taught  that  the  arteries  arise  from 
the  heart,  have  coats  six  times  as  thick  as  the  veins, 
and  that  they  carry  blood  and  pneuma.  He  called 
the  pulmonary  artery  the  arterious  vein,  named  the 
duodenum  according  to  its  length,  noted  the  termi- 
nation of  the  lacteals  in  gland-like  bodies.  He  de- 
scribed the  liver  with  some  care,  comparing  the 
liver  of  man  with  that  of  the  lower  animals.  He 
examined  the  salivary  glands,  the  pancreas,  the 


ROMAN  ANATOMY  AND  SURGERY    51 

hyoid  bone,  and  named  the  prostate.  We  also  owe 
to  Herophilus  an  early  account  of  the  testicles, 
epididymis,  vas  deferens,  seminal  vesicles,  the 
uterus,  the  structure  of  the  ovaries,  the  spermatic 
artery,  the  spermatic  vein  (even  the  relation  of  the 
left  spermatic  to  the  renal),  as  well  as  the  uterine 
vessels.  He  wrote  a  treatise  on  the  eye,  describing 
the  three  coats  and  the  vitreous  humor,  and  he  im- 
proved the  operation  for  cataract.  This  pioneer  in 
human  dissection  practiced  general  surgery  and 
wrote  a  work  on  obstetrics.  Through  his  teachers 
he  was  in  touch  with  the  traditions  of  both  Cos  and 
Cnidus.  He  developed  the  diagnostic  methods  of 
his  master  Praxagoras,  and  was  the  first  to  describe 
the  dicrotic  pulse.  He  held  the  teachings  of  Hippo- 
crates in  reverence,  and  did  not  abandon  the  doc- 
trine of  the  four  humors.  In  spite  of  conservatism 
in  this  respect,  Herophilus  preferred  observation 
and  experience  to  theory,  and  was  the  first  to  make 
post-mortem  examinations. 

Erasistratus,  born  about  330  B.C.,  through  his 
master  Metrodorus  came  under  the  influence  of  the 
teachings  of  Aristotle  and  of  the  school  of  Cnidus. 
He  was  the  exponent  of  a  more  exact  method  in 
medical  science  than  had  prevailed  before  his  time, 
and  as  an  anatomist  and  surgeon  was  not  inferior  to 
his  great  contemporary  Herophilus.  He  was  more 
exact  than  Aristotle  or  the  Hippocratic  writings  in 


52       THE  HISTORY  OF  MEDICINE 

a 
the  description  of  the  heart,  ,its  chordae  tendineze 

and  its  valves,  and  named  the  tricuspid  and  sig- 
moid.  He  also  gave  the  trachea  its  name,  and  ex- 
plained the  function  of  the  epiglottis.  He  observed 
the  lacteals  in  lower  animals  and  in  man.  By  post- 
mortem examination  he  learned  of  the  hardening 
of  the  liver  in  cases  of  dropsy,  as  well  as  of  the 
anatomical  conditions  following  pleurisy  and  a  cer- 
tain kind  of  snake-bite.  We  are  indebted  to  Erasis- 
tratus  for  a  careful  description  of  the  normal  liver. 
Though  recognizing  design  in  the  structure  of  the 
body,  he  regarded  some  parts  —  the  spleen,  for 
example  —  as  serving  no  purpose.  He  failed  also  to 
discover  the  function  of  the  bile,  and,  rejecting  the 
doctrine  of  the  four  humors,  greatly  developed  the 
doctrine  of  the  pneuma.  Like  Diocles  he  taught 
that  the  pneuma  is  renewed  by  respiration.  When 
the  lungs  are  expanded,  and  a  vacuum  thus  is 
created,  the  air  enters  by  the  trachea,  bronchi,  and 
bronchial  tubes.  When  the  heart  dilates,  the  air 
advances  from  the  anastomoses  of  the  bronchial 
tubes  to  the  arterioles,  and  thence  by  the  pulmonary 
vein  (called  by  him  the  "venous  artery")  to  the 
central  organ.  On  the  contraction  of  the  heart  the 
pneuma  is  forced  through  the  aorta  into  the  general 
arterial  system,  that  part  which  feeds  the  intelli- 
gence passing  to  the  brain.  Erasistratus  denied,  in 
agreement  with  Praxagoras,  the  principle  of  inter- 


ROMAN  ANATOMY  AND  SURGERY  53 

nal  heat,  and  held  that  the  pneuma  and  the  blood 
are  the  sources  of  the  body's  energy.  The  blood  is 
formed  from  food,  and  digestion  is  a  trituration 
process,  not  a  coction.  Following  up  his  endeavor 
to  reduce  physiology  to  mechanical  principles,  he 
tried  to  prove  by  experiments  with  birds  that  there 

• 

may  occur  a  loss  of  body  weight  other  than  that  due 
to  visible  excretions.  Disease  is  generally  caused  by 
plethora,  an  overfilling  of  the  vessels.  Inflamma- 
tion and  fever  are  the  result  of  the  plethora  of  the 
veins;  arthritis  is  the  manifestation  of  plethora  in 
the  joints.  The  presence  of  blood  in  the  arteries  is 
pathological,  due  to  the  overfilling  of  the  veins  or  to 
a  vacuum  in  the  arteries  following  the  escape  of 
pneuma.  Naturally  Erasistratus  was  unable  to 
anticipate  the  distinction  drawn  by  modern  science 
between  venous  blood  and  arterial,  but  it  is  evident 
that  he  turned  to  account  the  physical  science  of  his 
own  times.  In  spite  of  his  theory  of  plethora  he 
seldom  resorted  to  venesection.  He  likewise  ab- 
stained from  tapping  the  abdomen  in  dropsy,  be- 
cause the  operation  affected  merely  a  symptom  and 
did  not  strike  at  the  cause  of  the  disease.  Era- 
sistratus invented  an  S-shaped  catheter.  He  em- 
ployed a  hook-shaped  knife  to  extract  the  dead 
foetus,  and  is  said  to  have  opened  the  abdomen  in 
order  to  apply  medicaments  directly  to  _the  liver 
and  spleen. 


54       THE  HISTORY  OF  MEDICINE 

According  to  the  Latin  writer,  Aulus  Cornelius 
Celsus,  Herophilus  and  Erasistratus  "procured 
criminals  out  of  prison,  by  royal  permission,  and, 
dissecting  them  alive,  contemplated,  while  they 
were  still  breathing,  the  parts  which  nature  had 
before  concealed,  considering  their  position,  color, 
figure,  size,  order,  hardness,  softness,  smoothness, 
and  asperity."  This  hideous  practice,  already 
alluded  to,  found  advocates  and  apologists  among 
the  Greeks,  some  holding  "it  is  by  no  means  cruel, 
as  most  people  represent  it,  by  the  tortures  of  a  few 
guilty,  to  search  after  remedies  for  the  whole  inno- 
cent race  of  mankind  in  all  ages."  Celsus,  however, 
considered  this  sort  of  vivisection  £>oth  cruel  and 
superfluous,  though  dissection  is  necessary  for  in- 
struction. We  learn  from  him  that  Ammonius,  the 
Alexandrian  lithotomist,  was  accustomed  to  split  in 
pieces,  by  means  of  an  instrument,  calculi  too  large 
to  be  removed  from  the  bladder  whole.  Celsus  also 
makes  mention  of  Heraclides  of  Tarentum  (230 
B.C.),  to  whom  it  first  occurred  to  adapt  to  the  re- 
duction of  dislocations  the  mechanical  inventions 
of  Archimedes.  Heraclides  was  the  greatest  of  the 
Empirics,  a  medical  sect  who  thought  that  success 
in  practice  did  not  depend  upon  a  knowledge  of 
philosophy  or  science,  and  that  it  is  more  important 
to  heal  disease  than  to  know  its  cause.  According  to 
them,  physicians,  as  was  obviously  the  case  with 


ROMAN  ANATOMY  AND  SURGERY    55 

farmers  and  sailors,  were  in  no  need  of  theoretic  in- 
struction. To  Heraclides,  the  best  product  of  this 
narrow  school  of  medical  thought,  we  are  indebted 
for  the  investigation  of  the  effects  of  numerous 
drugs,  including  opium. 

Celsus,  who  flourished  in  the  early  part  of  the  first 
century  A.D.,  was  a  Roman  patrician  and  author, 
who  must  be  considered  an  enlightened  amateur 
and  not  a  professional  physician.  Of  his  encyclo- 
paedic writings  dealing  with  the  so-called  Arts  — 
agriculture,  medicine,  war,  rhetoric,  philosophy, 
and  jurisprudence  —  only  one  complete  work  sur- 
vives, namely,  "De  medicina,  libri  octo."  It  is 
based  on  the  \frritings  of  the  Hippocratic  and  Alex- 
andrian epochs  and  on  the  Greek  medical  works  of 
his  contemporaries.  It  displays  a  good  knowledge 
of  osteology,  particularly  of  the  skull  with  its  su- 
tures, foramina,  maxillary  bones,  etc.  It  shows 
that  its  author  held  a  correct  view  of  the  part 
played  by  cartilage  in  the  articulations,  and  of  the 
difference  in  form  between  the  male  and  female 
pelvis.  Among  various  other  matters  Celsus  speaks 
of  the  carotid  arteries,  and  the  cervical  glands.  In 
the  neck  there  begin  two  passages.  Of  these  alterum 
asperam  arteriam  nominant,  alterum  stomachum. 
Arteria  exterior  ad  pulmonem,  stomachus  interior  ad 
ventriculum  fertur:  ilia  spiritum,  hie  cibum  recipit. 
The  oesophagus  (stomachus}  was  known  to  lead  to 


56       THE  HISTORY  OF  MEDICINE 

the  stomach  (ventriculus) ;  while  the  trachea  (ar- 
teria)  carries  air  or  spirit  to  the  lungs. 

The  anatomy  found  in  the  "De  medicina"  is 
largely  incidental,  but  surgery  is  the  exclusive  topic 
of  two  of  the  eight  parts  into  which  the  work  is 
divided.  Very  little  is  known  of  the  practice  of 
surgery  at  Rome  before  the  time  of  Celsus,  but  he 
makes  mention  of  Asclepiades  (about  100  B.C.), 
who  by  his  tact  and  urbanity  succeeded  in  gaining 
for  Greek  medicine  a  foothold  in  the  Roman  metro- 
polis. Asclepiades  advised  tracheotomy  in  certain 
cases,  employed  venesection  with  discretion,  and 
noted  two  instances  of  spontaneous  dislocation  of 
the  femur.  However,  the  distinction  between 
surgeons  and  physicians  was  definitely  made  among 
the  Romans,  and  Asclepiades  was  known  as  a 
physician  rather  than  as  a  surgeon.  He  taught  that 
the  body  consists  of  an  infinite  number  of  atoms, 
which  surround  countless  minute  tubular  spaces  or 
pores,  a  doctrine  that  became  the  fundamental 
principle  of  the  Methodic  school  of  medical  thought. 

The  pages  of  Celsus  enable  us  to  see  the  progress 
made  in  surgery  between  the  fifth  century  B.C.  and 
the  first  century  A.D.  For  example,  ligature  was 
unknown  in  the  Hippocratic  era,  but  Celsus,  after 
discussing  various  methods  of  arresting  haemorrhage 
—  the  application  of  dry  lint,  cold,  compression, 
vinegar,  corrosives,  and  caustics  —  writes: " Finally, 


ROMAN  ANATOMY  AND  SURGERY    57 

if  the  bleeding  continues,  the  vessels  which  dis- 
charge the  blood  are  to  be  taken  hold  of  and  tied 
on  both  sides  of  the  wounded  part,  and  cut  through 
in  order  that  they  may  retract."  In  case  that  such 
procedure  is  impracticable,  the  red-hot  cautery  is  to 
be  applied  to  the  bleeding  vessel.  Sometimes  the 
application  of  a  cupping  instrument  near  the  point 
of  haemorrhage  may  prove  effective. 

Contrary  to  the  supposition  of  one  of  our  writers 
of  general  history  the  removal  of  limbs  by  amputa- 
tion was  practiced  by  surgeons  before  Harvey 
demonstrated  the  circulation  of  the  blood.  In  fact, 
the  Father  of  Medicine,  in  cases  of  gangrene,  where 
loss  of  limb  became  inevitable,  ventured  to  assist 
nature  by  amputating  at  the  line  of  demarcation. 
It  is  to  Celsus,  however,  that  we  are  indebted  for  the 
first  detailed  description  of  amputation.  Speaking 
of  him  a  great  modern  surgeon,  Lord  Lister,  who 
will  be  the  subject  of  a  subsequent  chapter,  writes: 
"He  directed  that  the  soft  parts  should  be  divided 
with  a  knife  down  to  the  bone,  and  then  dissected 
up  from  it  for  some  distance,  so  as  to  allow  the  saw 
to  be  applied  at  a  higher  level.  The  rough  surface  of 
the  sawn  bone  was  then  to  be  smoothed  off,  and  the 
soft  parts,  which,  as  he  tells  us,  will  be  lax  if  this 
plan  be  pursued,  were  to  be  brought  down  so  as  to 
cover  the  end  of  the  bone  as  far  as  possible.  This 
method  seems  calculated  to  afford  good  results; 


58       THE  HISTORY  OF  MEDICINE 

V 

particularly  as  it  appears  probable  from  his  writings 
that  Celsus  employed  the  ligature  for  arresting 
haemorrhage  after  amputation,  and  dressed  the 
stump  in  a  manner  favorable  to  the  occurrence  of 
primary  union." 

From  the  lucid  pen  of  Celsus  we  have  also  de- 
scriptions of  plastic  surgery,  of  lithotomy,  the 
couching  of  cataract,  venesection,  trephining,  relief 
of  phinaosis,  urethrotomy,  resection,  the  surgical 
treatment  of  hernia,  cancer  of  the  lip,  vomica  of  the 
liver,  and  many  other  operative  procedures.  He 
mentions  suture  of  the  abdominal  wall  (including 
the  peritoneum)  and  of  the  intestines,  recognizes 
the  advantage  to  the  surgeon  of  ambidexterity,  and 
gives  the  four  classical  symptoms  of  inflammation 
(Note  vero  inflammationes  sunt  quatuor,  rubor  et 
tumor,  cum  color  e,  et  dolor e).  There  have  been  dis- 
covered in  the  ruins  of  Pompeii  surgical  instruments 
that  throw  further  light  on  the  practice  of  the  first 
century  of  the  Christian  era.  These  include  iron 
bistouries,  bronze  forceps  and  cupping  instruments, 
a  lancet  with  silver  blade  and  bronze  handle,  probes, 
a  double  anal  speculum,  a  three-bladed  uterine,  and 
an  S-shaped  catheter.  Pliny,  who  was  a  victim  of 
the  same  eruption  of  Vesuvius  (79  A.D.)  as  destroyed 
the  city  of  Pompeii,  mentions  an  artificial  iron  hand, 
which  was  the  product,  however,  of  a  much  earlier 
period  than  his  own. 


ROMAN  ANATOMY  AND  SURGERY  59 

The  age  following  that  of  Celsus  was  one  of  the 
most  brilliant  in  the  history  of  anatomy  and  surg- 
ery, though  only  a  small  fraction  of  the  medical 
literature  of  the  time  is  now  in  existence.  Marinus, 
who  lived  in  the  time  of  Nero  (54-68  A.D.),  was  the 
author  of  numerous  books  on  anatomy.  He  is 
known  for  his  careful  study  of  the  muscles,  glands, 
and  nerves.  He  described  seven  pairs  of  cranial 
nerves,  including  the  auditory,  facial,  and  hypo- 
glossal.  His  knowledge  was  gained  by  dissection, 
as  well  as  by  animal  vivisection  and  experimenta- 
tion. About  the  time  that  the  warlike  Trajan,  with 
the  most  highly  organized  armies  the  Roman 
Empire  had  seen,  was  extending  his  dominions  to 
their  utmost  limits  and  celebrating  his  triumphs  by 
the  exhibition  of  ten  thousand  gladiators,  there 
lived  among  his  subjects  Leonides,  Rufus,  Archi- 
genes,  Aretaeus,  Heliodorus,  and  Soranus  of  Ephesus. 
The  last-named  was  the  greatest  gynecologist  and 
obstetrician  of  antiquity.  He  made  use  of  the 
obstetric  chair,  practiced  version  in  order  to  induce 
head  presentation,  and  he  discarded  the  old  rough 
methods  of  treating  pregnant  women  (jolting  on 
ladders,  etc.)  which  had  been  handed  down  by  the 
Asclepiads  of  Cnidus.  Soranus  had,  before  going  to 
Rome  at  the  end  of  the  first  century  B.C.,  been 
trained  in  anatomy  at  Alexandria.  He  contributed 
to  the  development  of  general  surgery,  especially 


60       THE  HISTORY  OF  MEDICINE 

the  treatment  of  fractures,  and  of  injuries  of  the 
head,  as  well  as  to  various  other  departments  of  the 
healing  art.  Unlike  his  great  contemporaries,  who 
were  adherents  of  the  Pneumatic  or  Eclectic  schools 
of  medical  thought,  Soranus  was  a  Methodist, 
following  Asclepiades  in  medical  doctrine  and  Epi- 
curus, the  disciple  of  Democritus,  in  philosophy. 
He  was  naturally  opposed  to  all  forms  of  supersti- 
tion, and  tried  to  persuade  the  mid  wives  to  abjure 
their  reliance  on  dreams  and  the  practice  of  mystic 
rites  and  antiquated  customs.  The  influence  of 
Soranus  was  greatly  extended  through  the  transla- 
tion and  interpretation  of  Caelius  Aurelianus  (fifth 
century  A.D),  the  only  distinguished  writer  on  medi- 
cine, except  Celsus,  to  employ  the  Latin  language 
during  the  period  of  the  Roman  Empire. 

Rufus  of  Ephesus  was  educated  at  Alexandria, 
dissected  monkeys  and  other  animals,  and  experi- 
mented on  live  specimens.  He  knew  that  all  bodily 
function  is  under  the  control  of  the  nervous  system. 
He  was  acquainted  with  the  recurrent  laryngeal 
nerve,  and  produced  loss  of  voice  and  of  sensibility 
by  compressing  the  pneumogastric  in  the  region 
of  the  carotid  arteries.  He  discovered  the  optic 
chiasma,  described  the  capsule  of  the  lens,  and  the 
tortuous  course  of  the  uterine  artery.  As  a  surgeon 
Rufus  employed  torsion  of  arteries  and  digital  com- 
pression, as  well  as  other  means,  for  the  arrest  of 


ROMAN  ANATOMY  AND  SURGERY  61 

haemorrhage.  He  associated  Filaria  medinensis 
with  impure  drinking-water,  and  described  leprosy, 
which  at  about  this  time  was  carried  to  the  West  by 
the  returning  Roman  legions,  as  well  as  bubonic 
plague,  traumatic  erysipelas,  and  other  diseases. 

Flap  amputations  were  performed  by  Leonides 
of  Alexandria,  and  by  the  two  greatest  surgeons  of 
the  time  of  Trajan  —  Archigenes  and  Heliodorus, 
who,  like  Rufus,  both  employed  torsion  of  vessels  to 
arrest  haemorrhage.  "Amputation  above  the  elbow 
or  knee,"  writes  Heliodorus,  "is  very  dangerous 
owing  to  the  size  of  the  vessels  divided.  Some 
operators  in  their  foolish  haste  cut  through  all  the 
soft  parts  at  one  stroke,  but  it  seems  to  me  better 
to  first  divide  the  flesh  on  the  side  away  from  the 
vessels,  and  then  to  saw  the  bone,  so  as  to  be  ready 
at  once  to  check  the  bleeding  when  the  large  vessels 
are  cut.  And  before  operating  I  am  wont  to  tie  a 
ligature  above  the  point  of  amputation."  Speaking 
of  operating  for  hernia  he  writes,  "We  ligature  the 
larger  vessels,  but  as  for  the  smaller  ones  we  catch 
them  with  hooks,  and  twist  them  many  times,  thus 
closing  their  mouths."  Even  more  relevant  is  his 
description  of  a  minor  amputation.  "A  circular 
incision,"  he  writes,  "is  made  round  the  digit  near 
its  base.  From  this  two  vertical  incisions  are  made 
opposite  one  another  and  the  flaps  so  formed  dis- 
sected up.  The  base  being  thus  laid  bare,  the  digit  is 


62       THE  HISTORY  OF  MEDICINE 

to  be  removed  by  cutting  forceps,  and  the  flaps  are 
then  brought  together  and  sutured."  Heliodorus 
undertook  resections,  and  the  removal  of  exostoses, 
and  treated  stricture ;  by  internal  urethrotomy. 
Archigenes  performed  amputations  not  only  for  gan- 
grene and  severe  injuries,  but,  in  case  of  malignant 
tumor  or  great  deformity,  constricting  the  limb 
above  the  point  of  amputation,  cutting  down  upon 
the  chief  arteries  and  ligaturing  them.  He  removed 
mammary  and  uterine  cancers,  employed  the  vag- 
inal speculum,  treated  injuries  of  the  head,  etc. 
Heliodorus  is  known  only  as  a  surgeon,  but  Archi- 
genes excelled  in  many  departments  of  medicine. 
Aretseus  was  probably  indebted  to  Archigenes  for 
his  knowledge  of  the  vascular  system,  of  the  struc- 
ture of  the  kidney  and  other  organs,  as  well  as  for 
much  of  his  clinical  wisdom.  In  the  pages  of  Aretseus 
are  found  classical  descriptions  of  phthisis,  tetanus, 
diphtheria,  epilepsy  with  its  aura,  satyriasis,  dia- 
betes, and  elephantiasis.  These  are  written  in  the 
Hippocratic  spirit.  They  are  not  case  histories, 
however,  but  generalized  pictures  that  enable  the 
clinician  to  know  each  species  of  disease  in  its  ante- 
cedents, development,  and  probable  outcome  in  in- 
dividual cases.  Aretaeus  introduced  the  term  "syn- 
cope" into  pathology,  and  established  the  distinc- 
tion between  paralysis  of  cerebral  origin,  involving 
decussating  fibers,  and  paralysis  of  spinal  origin. 


ROMAN  ANATOMY  AND  SURGERY  63 

Galen  (130-201  A.D.)  was  the  greatest  anatomist 
of  antiquity,  and,  after  Hippocrates,  the  greatest 
physician.  His  voluminous  writings  reflect  the 
spirit  of  the  highly  organized  Empire  of  the  An- 
tonines,  just  as  the  Hippocratic  writings  reflect  the 
freer  spirit  of  the  Periclean  age.  Galen,  born  at 
Pergamus,  directed  in  his  early  education  by  a  wise 
and  cultured  father,  was  early  initiated  in  the 
philosophy,  medicine,  and  general  learning  of  his 
time.  By  nature  and  training  an  Eclectic,  he  chose 
what  seemed  to  him  best  in  the  teachings  of  all  the 
schools  of  philosophy  and  all  the  medical  sects,  and 
ultimately  harmonized  all  these  in  a  system  of  his 
own.  He  was  a  professed  disciple  of  Hippocrates,  a 
votary  of  the  Asclepieion  of  Pergamus,  a  follower  of 
Aristotle,  a  student  of  the  works  of  Plato,  and  was 
indebted  for  parts  of  his  medical  doctrine  to  the 
dogmatic,  empiric,  pneumatic,  and  the  methodic 
schools  of  medical  thought. 

Galen  received  his  training  in  anatomy  at  Alex- 
andria and  other  places,  and  his  works  on  that  part 
of  medical  science  show  that  he  had  diligently 
studied  the  writings  of  the  great  Alexandrian 
anatomists,  of  Rufus  of  Ephesus,  and,  above  all,  of 
Marinus,  the  expert  dissector.  Galen  himself  ex- 
amined with  great  care  the  human  skeleton,  the 
muscles  of  the  Barbary  ape,  the  brain  of  the  ox,  the 
nervous  system  and  the  viscera  of  the  pig,  the 


64       THE  HISTORY  OF  MEDICINE 

• 
blood-vessels   of   the   embryo,   and   dissected   and 

vivisected  many  animals  —  goat,  fish,  snake,  etc. 
He  was  particularly  intent  on  the  function  of  each 
part  of  the  body,  and,  seeking  to  demonstrate 
design  in  nature  and  purpose  in  each  structure,  he 
closely  correlated  anatomy  and  physiology.  As  a 
youth  of  twenty,  he  had  written  three  books  on  the 
movement  of  the  lungs,  as  well  as  a  treatise  for  mid- 
wives  on  the  anatomy  of  the  uterus;  at  the  age 
of  twenty-eight,  as  physician  to  the  gladiators  of 
Pergamus,  he  showed  special  skill  in  the  treatment 
of  open  wounds  and  of  injuries  to  tendons;  and, 
leaving  his  native  city  for  the  world's  metropolis,  he 
at  the  age  of  thirty-two  demonstrated  before  the 
61ite  of  Roman  society  by  experiments  on  living 
animals  the  mechanism  of  the  nerves  and  muscles. 
Galen's  contributions,  however,  to  the  knowledge 
of  structure  are  found  in  almost  every  department 
of  the  study  of  anatomy.  His  descriptions  of  bones 
and  ligaments  approach  the  standard  of  the  present 
day.  He  classified  the  vertebrae  as  cervical,  dorsal, 
and  lumbar,  and  employed  the  terms  "apophysis," 
"epiphysis,"  "symphysis."  He  knew  in  animal 
dissection  the  seven  muscles  of  the  eye,  named  the 
platysma,  first  described  the  popliteus  and  the 
interossei  muscles,  and  explained  the  nature  of  the 
muscles  involved  in  mastication,  respiration,  loco- 
motion, etc.  He  described  the  branches .  of  the 


ROMAN  ANATOMY  AND  SURGERY  65 

aorta,  the  ductus  arteriosus,  the  three  coats  of  the 
arteries,  was  aware  of  the  anastomoses  of  the 
minute  veins  and  arteries,  proved,  by  ligaturing  the 
femoral  artery  in  two  places  and  making  an  incision 
between  the  two  ligatures,  that  the  arteries  contain 
blood.  He  gave  directions  for  the  dissection  of  the 
brain,  recognized  the  pituitary  body  and  the  in- 
fundibulum;  by  dividing  the  hemisphere  exposed 
the  corpus  callosum  and  the  fornix;  by  making 
sections  he  studied  the  ventricles,  the  corpora 
quadrigemina,  and  other  parts  of  the  cerebrum;  he 
mentioned  the  vermiform  process  of  the  cerebellum. 
He  carefully  traced  the  course  of  the  trigeminal, 
auditory,  facial,  glossopharyngeal,  and  other  cranial, 
as  also  the  course  of  the  spinal  nerves,  and  the 
connections  of  the  vagus  and  sympathetic.  Galen 
described  the  pleura  and  the  pericardium,  lungs, 
heart,  and,  very  carefully,  the  abdominal  organs, 
following  Herophilus  in  the  description  of  the  geni- 
tals. More  impressive  than  even  his  knowledge  of 
neurology  or  osteology  is  the  method,  systematic 
and  comprehensive,  displayed  by  Galen  in  his 
treatises  on  anatomy. 

As  already  implied,  much  of  his  knowledge  of 
anatomy  is  bound  up  with  physiological  discussions. 
He  was  able  to  observe  the  motion  of  the  exposed 
heart  in  two  patients,  and  noted  that  the  heart  con- 
tinued to  beat  in  vivisected  animals  after  the  large 


66       THE  HISTORY  OF  MEDICINE 

vessels  had  been  cut.  The  blood  of  the  right  heart 
is  thick  and  black.  Part  of  it  is  carried  to  the  lungs 
by  the  pulmonary  artery,  while  another  part  passes 
through  the  interventricular  septum,  permeable 
according  to  Galen.  This  is  converted  in  the  left 
heart  into  the  thinner  and  redder  blood  of  the 
arteries  by  the  action  of  the  pneuma,  which  enters 
by  way  of  the  pulmonary  veins  after  each  respira- 
tion and  the  diastole  of  the  heart,  the  inhaled  air 
acting  on  the  blood  like  a  blast  on  dying  charcoal. 
From  the  left  heart  the  blood,  mixed  with  much 
pneuma,  enters  the  arteries.  Galen's  investigation 
of  the  functions  of  the  nervous  system  likewise  in- 
volved considerable  knowledge  of  anatomy.  With 
a  sword-like  steel  scalpel  he  sectioned  the  spinal 
cord  of  the  pig  at  different  levels.  Transverse  sec- 
tions above  the  second  cervical  vertebra  caused 
sudden  death ;  a  section  between  the  third  and  fourth 
cervical  vertebrae  paralyzed  respiration;  a  section 
between  the  seventh  cervical  and  the  first  dorsal 
was  followed  by  a  limitation  of  the  respiratory 
movement  to  the  diaphragm  and  the  muscles  of  the 
thorax.  By  cutting  or  constricting  the  recurrent 
laryngeal  nerves  Galen  produced  aphonia,  and  by 
cutting  the  fifth  cervical  paralyzed  the  scapular 
muscles.  He  knew  that  nerve  trunks  carry  motor, 
or  sensory,  or  motor  and  sensory,  impulses.  He 
cured  a  patient  who  had  experienced  loss  of  sensa- 


ROMAN  ANATOMY  AND  SURGERY    67 

tion  in  the  fourth  and  fifth  fingers  of  the  left  hand 
by  using  counter-irritants  over  the  lower  cervical 
and  upper  dorsal  vertebrae.  This  bold  and  original 
experimental  physiologist  even  attempted  to  de- 
termine the  functions  of  parts  of  the  cerebrum, 
which  he  regarded  as  the  seat  of  mental  life,  by 
removing  the  brain  of  a  pig  section  by  section. 

After  settling  in  Rome,  Galen,  like  Asclepiades, 
did  very  little  as  a  surgeon.  As  physician  to  the 
gladiators  in  his  native  city  he  had  made  use  of 
red-wine  dressings  in  the  treatment  of  wounds. 
Besides  his  early  success  in  the  treatment  of  in- 
juries, he  is  also  credited  with  the  first  mention  of 
traumatic  aneurism,  with  the  resection  of  the  rib, 
and  with  the  resection  of  the  sternum  for  caries 
(one  of  the  cases  of. exposure  of  the  heart  already 
mentioned).  His  works  speak  of  the  use  of  silk  and 
gut  ligatures,  of  bandaging,  of  the  treatment  of 
ulcers,  of  plastic  operations  on  the  nose,  lips,  and 
ears,  of  radical  operation  for  cancer  of  the  breast, 
etc.  By  regarding  suppuration  as  the  result  of  the 
coction  of  irritant  humors,  he  gave  support  to  the 
doctrine  of  laudable  pus,  which  was  not  seriously 
challenged  till  the  time  of  Theodoric  of  Lucca. 

After  the  time  of  Galen  anatomy  and  surgery 
within  the  bounds  of  the  Roman  Empire  suffered 
a  rapid  decline.  Antyllus,  noted  for  his  treatment 
of  aneurism  and  of  cataract,  for  his  description  of 


68       THE  HISTORY  OF  MEDICINE 

plastic  operations  and  of  tracheotomy,  is  now  re- 
garded as  a  predecessor  of  Galen.  Oribasius  (325- 
403)  was  the  author  of  an  encyclopaedia  of  medicine, 
which  extended  the  influence  of  Galen  and  pre- 
served the  memory  of  Archigenes,  Heliodorus,  and 
Antyllus.  To  Aetius  of  Constantinople  (sixth  cen- 
tury A.D.)  we  are  likewise  indebted  for  information 
concerning  the  surgery  of  Rufus,  of  Leonides  (re- 
moval of  glandular  tumors  from  the  neck,  etc.),  and, 
particularly,  of  Archigenes.  His  voluminous  work 
gives  a  definite  account  of  the  surgical  treatment  of 
aneurism.  Alexander  of  Tralles  was  the  author  of  a 
"Practica."  With  these  Byzantine  compilers  is 
usually  mentioned  Paul  of  ^Egina  (625-690),  who 
wrote  an  "Epitome"  of  medicine  in  seven  books. 
Paul,  however,  was  an  expert  surgeon  and  described 
a  great  variety  of  operations.  His  treatment  of 
cataract  by  depression,  his  failure  to  perform 
thoracentesis  for  empyema,  an  operation  which  had 
been  known  in  Hippocratic  times,  his  neglect  of  the 
methods  of  version  followed  by  Soranus,  and  his 
practice  of  removing  the  testicles  in  case  of  scrotal 
hernia,  indicate  that  surgery  in  his  time  had  begun 
to  relapse  from  a  classical  to  a  medieval  standard. 
The  pages  of  the  "Epitome"  afford  some  insight 
into  the  practice  of  military  surgery  in  the  armies  of 
the  Roman  Empire. 
At  the  time  of  Trajan  there  had  been  twenty 


ROMAN  ANATOMY  AND  SURGERY    69 

cohorts  of  garrison  troops  of  one  thousand  to 
fifteen  hundred  men  each,  with  four  surgeons  to  the 
cohort.  Nine  cohorts  of  Pretorian  guards  were  in 
addition  provided  with  physicians.  In  the  rest  of 
the  Empire  there  were  thirty  legions  of  ten  cohorts 
and  about  sixty-five  hundred  men  each.  These 
troops  were  attended  by  surgeons  of  the  legion 
(medici  legionis),  probably  six  or  more  to  the  legion. 
They  wore  the  uniform  of  the  legionaries,  but  were 
counted  as  of  superior  rank.  In  the  fixed  camps 
there  were  special  medical  officers.  About  the  same 
time  mention  is  made  of  military  hospitals,  also 
provided  with  regular  superintendents.  In  the 
Roman  armies  of  the  sixth  century  every  troop  of 
two  hundred  to  four  hundred  men  was  accompanied 
by  eight  or  ten  men  on  horseback  to  pick  up  the 
wounded.  These  first-aid  men  carried  each  a  water 
flask,  and  received  a  gold  piece  for  every  man  they 
rescued.  In  the  military  hospitals  were  male 
nurses.  For  each  vessel  in  the  navy,  surgeons  were 
also  provided. 

REFERENCES 

Adams,   Francis:  *The  Extant   Works  of  Aret&us   (translation). 

London,  The  Sydenham  Society,  1846.    510  pp.;  The  Seven 

Books  of  Paulus  JEginata  (translation  in  three  volumes),  vol. 

n,  pp.  247-511.  London,  The  Sydenham  Society,  1846. 
Allbutt,  Sir  Clifford  T.:  Greek  Medicine  in  Rome.  London,  1921. 
Aristotle:    Historic,  Animalium  (English  translation  by  D'Arcy 

Wentworth    Thompson).     Oxford,  Clarendon  Press,    1910. 


70      THE  HISTORY  OF  MEDICINE 

Vol.  rv  of  the  Works  of  Aristotle,  edited  by  J.  A.  Smith  and 

W.  D.  Ross. 
Finlayson,    James:    "Celsus,"    Glasgow    Medical  Journal,   vol. 

xxxvn,  1892,  pp.  321-48;  "Erasistratus,"  ibid.,  vol.  xxxix, 

pp.  340-52;  "Galen,"  British  Medical  Journal,  1892,  vol.  I, 

PP-  573»  73°>  771!  "Herophilus,"  Glasgow  Medical  Journal, 

1893,  vol.  xxxix,  pp.  321-40. 

Meunier,  L6on:  Histoire  de  la  Medecine.    Paris,  1911.    642  pp. 
Marx,  K.  F.  H. :  Herophilus,  ein  Beitrag  zur  Geschichte  der  Medizin. 

Carlsruhe  and  Baden,  1838.     103  pp. 
Turner,    Sir    William:    "Anatomy,"  Encyclopaedia  Britannica, 

ninth  edition. 


CHAPTER  IV 

THE  TRANSMISSION  OF  MEDICAL  SCIENCE 
BY  THE  ARABS 

BEFORE  the  death  of  Paul  of  ^Egina  the  translation 
of  Greek  and  Syriac  medical  works  into  the  language 
of  the  Mohammedan  conquerors  of  Asia  Minor  had 
begun,  and  even  before  the  end  of  the  fifth  century 
the  medical  science  of  Constantinople  had  been 
carried  as  far  east  as  the  Persian  province  of  Khora- 
san  by  the  Nestorian  heretics.  The  school  and 
hospital  at  Gondisapor,  controlled  for  the  subse- 
quent centuries  by  this  Christian  sect,  became  the 
focus  from  which  Greek,  Syrian,  Persian,  and  In- 
dian medical  teachings  were  spread  among  the 
followers  of  the  Prophet.  Here  was  educated  the 
Arab  physician  Harets  ben  Kaladah,  who,  though 
a  Christian,  became  the  adviser  of  Mohammed  in 
those  hygienic  and  medical  matters  which  Islam, 
like  Judaism,  made  a  part  of  religion.  When  the 
Arab  conquerors  overran  Mesopotamia  and  Persia, 
they  left  undisturbed  their  fellow  monotheists,  the 
Nestorian  physicians  of  Gondisapor.  Among  these 
about  the  middle  of  the  eighth  century  certain 
Syrian  families,  the  Bachtishuas,  Messuas,  and 
Serapions,  were  especially  prominent  as  translators. 


72       THE  HISTORY  OF  MEDICINE 

In  765  George  Bachtishua,  whose  influence  had  for 
a  time  been  supreme  in  the  school  and  hospital  of 
Gondisapor,  was  called  to  the  recently  founded  city 
of  Bagdad  by  the  Abbaside  Caliph  al  Mansur,  who 
induced  him  to  undertake  the  translation  of  a 
number  of  medical  works  into  Arabic.  He  returned 
to  Khorasan  before  his  death  in  771,  but  his  son  was 
later  summoned  to  the  court  of  Harun  al  Rashid, 
and  the  grandson  Gabriel  and  the  great-grandson 
were  famous  in  the  times  of  that  Caliph  and  his 
successors. 

The  Arabian  Nights  throws  a  curious  light  on  the 
medical  knowledge  and  general  culture  of  the  East- 
ern Caliphate  at  the  beginning  of  the  ninth  century. 
Readers  of  the  story  of  Abu  al  Husn  and  his  Slave- 
Girl  will  recall  how  the  hero  "ate  and  drank,  and 
made  merry  and  took  his  pleasure,  and  gave  gifts 
of  gear  and  coin  and  was  profuse  with  gold,  and 
addressed  himself  to  eating  fowls  and  breaking  the 
seal  of  wine-flasks  and  harkening  to  the  giggle  of 
the  daughter  of  the  vine  as  she  gurgled  from  the 
flagon,  and  enjoying  the  jingle  of  the  singing  girls; 
nor  did  he  give  over  this  way  of  life  till  his  wealth 
was  wasted  and  the  case  worsened  and  all  his  goods 
went  from  him,  and  he  bit  his  hands  in  bitter 
penitence."  Then  the  slave-girl,  the  last  of  Abu 
al  Husn's  possessions,  said:  "O  my  lord,  carry  me 
to  Harun  al  Rashid,  fifth  of  the  Abbasides,  and 


MEDICAL  SCIENCE  OF  THE  ARABS    73 

seek  of  him  to  my  price  ten  thousand  dinars." 
When  she  is  brought  before  the  Caliph,  her  accom- 
plishments and  acquisitions  are  submitted  to  rigid 
inquisition.  Among  the  various  branches  of  learning 
open  to  students  of  the  time  she  had  not  neglected 
medicine.  She  proves  to  be  versed  in  the  four  ele- 
ments, the  four  humors,  the  three  kinds  of  spirits, 
the  five  senses,  the  three  ventricles  of  the  brain. 
The  number  of  veins  is  unknown,  though  some  have 
thought  to  fix  it  at  three  hundred  and  sixty.  There 
are  two  hundred  and  forty  bones,  and,  contrary  to 
the  teaching  of  Galen,  the  mandible,  the  sternum, 
and  the  sacrum  —  intermediate  between  the  verte- 
brae and  the  coccyx  —  consist  of  one  bone  each. 
The  cause  of  all  sickness  is  repletion  and  indigestion. 
Scurvy  may  result  from  eating  salt  food  fasting. 
The  endive  is  the  most  excellent  of  vegetables. 
Fermented  liquor  banisheth  care  and  gladdeneth 
the  heart  of  man,  yet  its  sinfulness  is  greater  than 
its  use.  One  should  not  bathe  on  a  full  stomach. 
Yellowness  of  the  whites  of  the  eyes  is  indicative  of 
jaundice.  Medicine  is  taken  to  greatest  advantage 
when  Jupiter  and  Venus  are  in  the  ascendant. 
Cupping,  like  venesection,  should  be  practiced  in 
moderation,  and  it  should  be  performed  in  the  wane 
of  the  moon,  and  if  it  fall  on  a  Tuesday  and  in  the 
spring  of  the  year,  it  will  be  the  more  efficacious,  etc. 
From  these  fragments  it  is  evident  that  the  Slave- 


74       THE  HISTORY  OF  MEDICINE 

Girl's  medical  lore  is  borrowed  from  Greek,  Hebrew, 
Babylonian,  and  other  sources.  It  is  probable  that 
the  corrections  of  Galen's  osteology,  a  knowledge  of 
which  is  attributed  in  this  fourteenth-century  tale 
to  the  time  of  Harun  al  Rashid,  are  to  be  credited 
to  Abdollatif  (1162-1231),  who,  invited  to  visit 
Egypt  in  the  reign  of  Saladin,  enjoyed  greater  op- 
portunities of  studying  the  human  skeleton  than 
usually  came  to  Mohammedan  physicians. 

The  first  of  the  Messuas  to  rise  to  distinction 
spent  the  early  part  of  his  life  as  an  apothecary  at 
Gondisapor,  went  to  Bagdad  as  a  physician,  and, 
gaining  the  favor  of  Harun  al  Rashid  by  successful 
treatment  and  prognosis,  entered  into  rivalry  with 
Gabriel  Bachtishua.  Messua's  son,  usually  called 
Messua  the  Elder,  became  the  director  of  a  college 
of  translators  at  the  request  of  the  enlightened 
Caliph  al  Mamun  (813-833),  who  wished  to  see 
translated  into  the  Arabic  language  the  sciences  of 
all  the  lands  under  his  sway.  Messua  the  Elder  and 
Serapion  the  Elder  dispute  the  honor  of  having 
written  the  so-called  Aphorisms  of  Damascenus. 
Greater,  however,  as  a  translator  than  the  Bach- 
tishuas,  Messuas,  or  Serapions  was  Honain  ben 
Isaac  (809-873),  a  Christian  Arab  who  put  into  his 
native  tongue  the  works  of  Hippocrates,  Galen, 
Oribasius,  and  Paul  of  JEgina.,  and  who  wrote  a 
treatise  on  ophthalmology  and  a  commentary  on 


MEDICAL  SCIENCE  OF  THE  ARABS    75 

Galen  (Isagoge).  During  the  ninth  century  the  writ- 
ings of  Archigenes,  Dioscorides,  Rufus,  Aristotle  and 
other  Greeks  were  likewise  made  accessible  to  read- 
ers of  Arabic.  At  the  same  time  the  Arabs  revised 
Syriac  translations  from  the  Greek,  which  had  been 
made  by  Sergius  in  the  sixth  century,  and  translated 
a  Syriac  work  ("Practica")  written  by  Serapion. 

The  greatest  of  all  the  physicians  to  write  in  Ara- 
bic was  the  Persian  Rhazes  (860-932),  who  studied 
at  Bagdad  and  was  the  author  of  a  comprehensive 
work  on  medicine,  the  "Continens,"  a  briefer  work, 
the  "  Almansor,"  and  a  treatise  on  the  smallpox  and 
measles.  He  taught  that  inquietude,  anxiety,  and 
nausea  are  more  frequent  in  the  measles  than  in  the 
smallpox;  while,  on  the  other  hand,  pain  in  the  back 
is  more  peculiar  to  the  smallpox  than  to  the  measles. 
He  considered  these  diseases  (the  task  of  clearly 
differentiating  which  was  ultimately  accomplished 
by  an  English  clinician)  as  an  inevitable  accompani- 
ment of  a  natural  change  in  the  condition  of  the 
blood.  "Now  the  smallpox  arises,"  he  says,  "when 
the  blood  putrefies  and  ferments,  so  that  the  super- 
fluous vapors  are  thrown  out  of  it,  and  it  is  changed 
from  the  blood  of  infants,  which  is  like  must,  into 
the  blood  of  young  men,  which  is  like  wine  perfectly 
ripened:  and  the  smallpox  itself  may  be  compared 
to  the  fermentation  and  effervescence  which  takes 
place  in  must."  And  this  is  the  reason  why  children, 


76       THE  HISTORY  OF  MEDICINE 

especially  males,  rarely  escape  being  seized  with 
this  disease,  because  it  is  impossible  to  prevent 
must  —  the  nature  of  which  is  to  effervesce  and 
ferment  —  from  changing  into  the  state  that  super- 
venes. In  young  men,  the  maturation  of  the  blood 
having  been  established,  the  disease  seldom  occurs, 
except  in  those  cases  in  which  a  mild  form,  which 
has  not  brought  to  perfection  the  transition  of  the 
blood  from  the  first  state  to  the  second,  has  been 
suffered  in  childhood.  Old  men  are  not  susceptible 
except  in  pestilential,  putrid,  and  malignant  consti- 
tutions of  the  air,  in  which  this  disease  is  chiefly 
prevalent.  Rhazes  sought  by  treatment  to  bring  it 
about  that  the  unavoidable  change  in  the  blood 
"should  not  be  effected  all  at  once  and  in  a  short 
time,  with  ebullition  and  fermentation,  which  are 
accompanied  by  frightful  and  dangerous  accidents, 
but  little  by  little,  and  in  a  long  time,  and  gradually, 
by  way  of  ripening,  not  putrefaction,  and  without 
fevers."  He  even  sought  to  anticipate  the  occur- 
rence of  the  disease. 

There  is  no  doubt  that  Rhazes  was  markedly 
original  as  compared  with  other  writers  in  Arabic 
on  medicine.  He  was  called  the  "Experimenter." 
"I  do  not  suppose,"  he  says,  "that  any  great  harm 
would  happen  to  a  man  who  should  drink  metallic 
mercury  except  severe  pains  in  the  stomach  and 
intestines.  I  gave  some  to  an  ape  which  I  had,  nor 


MEDICAL  SCIENCE  OF  THE  ARABS    77 

did  I  see  any  evil  befall  him  beyond  that  above 
mentioned,  which  I  conclude  from  the  fact  that  he 
twisted  about,  and  kept  biting  at  his  stomach,  and 
pawing  it  with  his  hands."  He  made  use  of  mer- 
curial ointments,  and  gave  the  first  clear  description 
of  spina  ventosa.  Asked  to  choose  a  site  for  a 
hospital  in  Bagdad,  Rhazes  hung  pieces  of  meat  in 
different  parts  of  the  city  in  order  to  ascertain  the 
place  least  favorable  to  putrefaction.  Nevertheless, 
in  spite  of  the  evident  independence  of  his  spirit,  he 
insisted  on  the  value  to  the  physician  of  supple- 
menting personal  experience  by  a  knowledge  of  the 
history  of  the  medical  profession.  And  when  we 
turn  to  his  larger  works,  which  also  treat  of  smallpox 
and  measles,  we  find  to  what  an  extent  he  relied  on 
his  Greek  and  Arabic  predecessors.  In  the  "Con- 
tinens"  (the  ninth  book  of  which  was  in  the  six- 
teenth century  translated  into  Latin  by  Vesalius) 
he  refers  to  a  dozen  writers  who  had  turned  their 
attention  to  the  study  of  smallpox  before  his  time. 
These  include  Aaron,  a  Christian  priest  and  physi- 
cian, who  had  flourished  at  Alexandria  in  the  first 
half  of  the  seventh  century;  Isaac,  son  of  Honain, 
more  distinguished  as  a  physician,  no  less  expert  as 
a  translator,  than  his  father ;  and  Messua  the  Elder, 
who  had  anticipated  what  seemed  most  original  in 
Rhazes,  the  view  that  smallpox  is  caused  by  an 
innate  contagion,  or  ferment,  in  the  blood. 


78       THE  HISTORY  OF  MEDICINE 

Two  other  Persian  physicians,  Haly  Abbas  and 
Avicenna,  preserved  in  encyclopaedic  works  written 
in  Arabic  the  medical  science  of  the  ancients.  The 
"Liber  Regis"  of  the  former  is  largely  based  on 
Galen,  and  epitomizes  the  knowledge  of  the  Arabs 
of  the  tenth  century.  It  contains  a  good  account  of 
the  symptoms  and  treatment  of  diabetes,  a  disease 
that  had  been  described  by  Aretseus  and  by  one  of 
the  great  physicians  of  India;  it  refers  to  anthrax, 
which  was  probably  known  to  Rhazes  as  well  as  to 
Hippocrates,  whom  Haly  Abbas  regarded  as  the 
prince  of  the  medical  art.  The  book  also  gives 
directions  for  the  treatment  of  melancholy  and  other 
forms  of  mental  disorder.  Haly  Abbas  advocated 
the  search  for  new  drugs,  the  virtues  of  which  should 
be  tested  on  animals.  He  held  that  the  student  of 
medicine  should  not  neglect  the  opportunities 
offered  for  observation  in  hospital  and  private 
practice.  Avicenna  (980-1036)  in  his  "Canon" 
gave  systematic  and  logical  expression  to  Arabic 
medical  science.  He  based  his  doctrines  on  those  of 
Aristotle  and  Galen,  and  he  is  particularly  compar- 
able with  the  latter  as  a  medical  philosopher,  whose 
writings  mark  the  culmination  of  a  long  period  of 
development.  His  book  supplanted  the  "Conti- 
nens"  and  the  "Liber  Regis,"  and  for  centuries 
continued  to  be  the  authoritative  textbook  of  medi- 
cine in  the  Western  world,  as  well  as  in  the  Eastern, 


MEDICAL  SCIENCE  OF  THE  ARABS    79 

where,  indeed,  its  influence  is  still  dominant. 
Avicenna  described  leprosy,  already  known  to 
Aretaeus ;  treated  spinal  deformities,  as  had  Hippoc- 
rates, by  forcible  reduction;  observed  filaria  medi- 
nensis,  as  had  Leonides  of  Alexandria,  not  to  men- 
tion Agatharcides  of  Cnidus  (second  century  B.C.), 
Soranus  of  Ephesus,  and  others.  Avicenna  empha- 
sized the  importance  of  diet  and  regimen,  and  paid 
particular  attention  to  skin  diseases  and  nervous 
affections.  Among  other  directions  for  determining 
the  value  of  drugs,  he  mentions  experiment  on 
human  beings.  He  was  bolder  than  Paul  of  ^Egina 
in  operating  for  empyema,  advocated  the  use  of 
forceps  in  obstetrics,  and,  though  addicted  to  the 
cautery  rather  than  the  knife,  employed  the  ligature 
as  one  of  the  means  of  checking  haemorrhage. 

Isaac  Judaeus  (850-950)  was  a  contemporary  of 
Rhazes  rather  than  of  Avicenna,  but  his  mention 
here  will  serve  to  mark  the  westward  migration  of 
Arabian  culture.  He  practiced  in  Egypt,  and  later 
settled  in  Kairwan  (Tunis),  the  sacred  city  of 
Northern  Africa.  He  was  known  for  his  treatment 
of  eye  troubles,  and  left  treatises  on  diet,  urine, 
fevers,  etc.  Besides  these  writings  in  Arabic,  he  is 
also  credited  with  producing  in  Hebrew  "The 
Physician's  Guide,"  which  reflects  the  wisdom  of 
an  experienced  practitioner,  as  the  following  quota- 
tions bear  witness.  "He  whose  business  it  is  to  bore 


8o       THE  HISTORY  OF  MEDICINE 

pearls  must  do  his  work  carefully  in  order  not  to 
mar  its  beauty  by  haste.  Even  so  he  who  under- 
takes the  cure  of  human  bodies,  the  noblest  crea- 
tions on  earth,  should  take  thought  upon  the 
diseases  with  which  he  comes  in  contact  and  give 
his  directions  after  careful  reflection,  so  that  he  fall 
into  no  irremediable  error.  .  .  .  The  chief  task  of  the 
physician  is  to  prevent  disease.  .  .  .  The  majority 
of  diseases  are  cured  by  nature.  The  more  you 
demand  for  your  treatment  and  the  more  highly 
you  esteem  your  cure,  so  much  the  higher  will  you 
stand  in  the  eyes  of  the  people.  Your  art  will  be 
held  of  no  account  only  by  those  whom  you  treat 
gratuitously.  .  .  .  Visit  not  the  patient  too  often, 
nor  remain  too  long  with  him,  unless  the  treatment 
demand  it,  for  it  is  only  the  fresh  encounter  that 
gives  pleasure." 

Albucasis  (912-1013),  Avenzoar  (  -1162), 
Averroes  (1126-98),  and  Moses  Maimonides  (1135- 
1204)  belong  to  the  Western  Caliphate.  Avenzoar 
was  born  in  the  neighborhood  of  Seville,  Albucasis 
near  Cordova;  while  the  other  two  were  born  in  that 
capital,  which  as  early  as  the  tenth  century  boasted 
one  million  inhabitants,  hundreds  of  mosques,  nu- 
merous and  splendid  public  libraries,  and  flourish- 
ing institutions  of  higher  learning  which  became  the 
models  of  the  later  European  universities.  Albucasis 
was  the  greatest  of  the  Arab  surgeons,  and  fully 


MEDICAL  SCIENCE  OF,  THE  ARABS    81 

recognized  the  value  to  the  surgeon  of  a  knowledge 
of  anatomy.  The  last  part  of  the  "Tasrif,"  or  col- 
lected works,  is  devoted  to  surgery,  and,  published 
separately  and  illustrated,  is  the  earliest  distinct 
work  on  that  subject.  It  is  based  on  the  sixth  book 
of  Paul  of  JEgina.  Albucasis,  as  was  usual  with  the 
Arab  physicians,  emphasized  the  importance  of  the 
cautery,  although  the  use  of  the  ligature  was  also 
known  to  him.  He  gave  directions  for  the  surgical 
treatment  of  defective,  loose,  and  irregular  teeth. 
He  described  a  case  of  extra-uterine  pregnancy, 
anticipated  the  Walcher  position  in  obstetric  cases 
with  presentation  of  knees  and  hands,  and  his 
illustrations  picture  forceps  with  crossed  handles. 
Albucasis  employed  a  more  developed  form  of 
syringe  than  the  bladder  fitted  with  a  reed  used  in 
antiquity,  and  was  aware  of  the  occurrence  of 
haemophilia,  and  of  salivation  following  the  external 
use  of  mercury.  "Avoid  perilous  practices,"  he 
writes,  "as  I  have  already  warned  you,  so  shall  you 
have  the  more  praise  and  profit,  if  God  will." 

Avenzoar  was  the  greatest  of  the  Arab  physicians 
after  the  time  of  Rhazes,  and  like  him  tempered  his 
reverence  of  the  past  with  a  self-respecting  reliance 
on  his  own  clinical  observations.  The  pages  of  his 
chief  work  "al-Teisir"  (Assistance)  report  a  number 
of  interesting  cases  —  an  abscess  of  the  pericardium 
which,  while  Avenzoar  was  still  a  student,  caused 


82       THE  HISTORY  OF  MEDICINE 

the  death  of  his  father,  an  abscess  of  the  mediasti- 
num from  which  he  himself  recovered  after  cough- 
ing up  sanious  matter,  an  inflammation  of  the 
middle  ear,  cancer  of  the  stomach,  a  hernia  cured 
by  rest.  In  the  case  of  a  patient  suffering  from  a 
paralysis  of  the  gullet  he  poured  milk  into  the 
stomach  by  means  of  a  tube  passed  into  the  oesopha- 
gus and  made  use  of  nutrient  enemata.  He  per- 
formed tracheotomy  experimentally  on  a  goat  and 
recommended  resort  to  that  operation  in  cases  of 
threatened  suffocation.  He  recognized  tuberculosis 
of  the  intestines,  and,  like  many  physicians  of 
antiquity,  prescribed  milk  for  phthisis.  "Some- 
times there  arise  on  the  body,"  he  says,  "under  the 
external  skin,  little  swellings  which  are  commonly 
called  'itch/  and  if  the  skin  be  removed  there  issues 
from  various  parts  a  very  small  beast,  so  small  that 
he  is  hardly  visible."  Avenzoar  was  a  surgeon  as 
well  as  a  physician,  and  justly  appreciated  the 
knowledge  of  osteology  and  of  anatomy  in  general. 
He  dedicated  his  great  medical  work  to  his  friend 
and  disciple  Averroes,  who  was  more  eminent  as  a 
philosopher  and  as  the  commentator  of  Aristotle 
than  as  a  physician,  though  he  wrote  a  work  —  the 
"Colliget" — on  the  general  principles  of  medicine. 
His  enthusiasm  for  the  teachings  of  Aristotle 
tended  to  weaken  the  authority  of  Galen,  who  for 
centuries  had  been  regarded  as  almost  infallible  in 


MEDICAL  SCIENCE  OF  THE  ARABS    83 

spite  of  the  independence  of  Avenzoar  and  other 
Arab  physicians.  As  a  philosopher  Averroes  did  not 
believe  in  personal  immortality,  and,  consequently, 
he  was  regarded  as  a  heretic  both  by  the  Christians 
and  by  the  Mohammedans.  Toward  the  end  of  the 
twelfth  century  Arabic  culture  in  Spain  was  checked 
by  a  recrudescence  of  orthodoxy,  and  after  the 
death  of  Averroes  the  medical  science  of  the  Arabs 
suffered  a  rapid  decline. 

The  great  Jewish  Rabbi  Moses  Maimonides, 
driven  from  his  native  country  by  the  persecution 
of  fanatics,  eventually  found  protection  and  patron- 
age at  Cairo  from  the  hands  of  the  tolerant  and 
enlightened  Sultan  Saladin.  It  was  in  response  to 
Saladin's  request  for  advice  on  matters  of  health 
that  Maimonides  prepared  his  most  interesting 
medical  treatise,  the  "Book  of  Counsel"  ("Trac- 
tatus  de  Regimine  Sanitatis").  In  the  preface, 
addressed  to  Saladin,  the  author  describes  the  four 
parts  comprised  in  the  treatise:  "The  first  is  a  brief 
explanation  of  the  general  rules  of  health ;  the  second 
is  for  those  sick  persons  who  cannot  find  a  physi- 
cian, or,  at  least,  not  one  whom  they  can  trust;  the 
third  contains  the  regimen  proper  for  my  lord's  case, 
as  it  has  been  described  to  me;  the  fourth  treats  of 
matters  useful  to  sick  and  well  in  all  times  and 
places."  Maimonides  wrote  also  a  commentary  on 
the  "Aphorisms"  of  Hippocrates,  summarized  the 


84       THE  HISTORY  OF  MEDICINE 

writings  of  Galen,  prepared  a  book  of  "Aphorisms" 
with  quotations  from  Galen  (whose  errors  and  in- 
consistencies, however,  he  does  not  hesitate  to  ex- 
pose), as  well  as  treatises  on  asthma,  on  poisons,  on 
dietetics,  and  a  translation  of  a  book  of  Avicenna. 
Like  that  Persian  physician  Maimonides  was  a 
disciple  of  Aristotle  and  of  Galen. 

The  chief  work  of  Haly  Abbas,  a  book  of  Galen's, 
the  "Aphorisms"  of  Hippocrates  with  the  comments 
of  Galen,  the  treatises  on  fevers  and  on  urine  of 
Isaac  Judaeus  were  translated  from  Arabic  to  Latin 
by  Constantine  the  African  in  the  eleventh  century. 
In  the  twelfth  century  Gerard  of  Cremona  did  a  like 
service  for  the  "Aphorisms"  of  Damascenus,  the 
"Practica"  of  Serapion  the  Elder,  the  "Canon"  of 
Avicenna,  a  part  of  the  writings  of  Rhazes,  Albu- 
casis,  and  other  Arab  physicians;  while  the  greater 
part  of  Galen  and  the  "Introduction"  ("Isagoge") 
of  Honain  were  likewise  translated.  The  "Colliget" 
of  Averroes  and  the  "Book  of  Counsel"  of  Mai- 
monides were  made  accessible  to  Christian  nations 
about  the  middle  of  the  thirteenth  century.  That 
very  much  of  the  medical  science  of  the  Arabs  was 
available  in  western  Europe  at  the  beginning  of  the 
fourteenth  century  is  manifest  in  the  pages  of  the 
"Rosa  Medicinae"  of  John  of  Gaddesden,  who  drew 
his  materials  from  translations  of  Greek,  Arabian, 
and  Jewish  physicians  and  from  the  works  of  Gil- 


MEDICAL  SCIENCE  OF  THE  ARABS    85 

bert  the  Englishman,  who  died  in  1250,  and  the 
French  physician  Bernard  de  Gordon,  who  taught 
at  Montpellier  from  1285  till  1307.  John  of  Gaddes- 
den  does  not  refer  to  the  writings  of  Avenzoar, 
which  were  later  translated  into  Latin  and  printed 
in  Venice  (1490).  The  English  physician,  however, 
knows  of  Avenzoar,  and  maintains  on  his  authority 
that  the  brilliant  smaragdus  found  in  the  head  of 
the  green  toad,  if  triturated  with  water  or  wine  and 
given  in  a  nine-grain  dose,  is  an  effective  emetic  in 
cases  of  poisoning. 

The  belief  in  astrology,  which  had  early  prevailed 
in  the  Orient,  spread  throughout  the  civilized  world, 
and  was  cultivated  at  Alexandria  and  Rome  long 
before  the  time  of  the  Arab  conquests.  Galen  shared 
the  superstitious  views  of  his  contemporaries  as 
regards  the  influence  of  the  heavenly  bodies  on 
one's  health  and  fate,  and,  though  his  disciple 
Avicenna  wrote  a  treatise  on  the  uselessness  of 
astrology,  this  pseudo-science  continued  to  form  a 
part  of  medical  teaching  for  centuries.  Purging  and 
blood-letting  were  regulated  in  accordance  with  the 
positions  of  the  planets  and  the  signs  of  the  zodiac. 
Medicinal  plants  were  gathered  under  the  appro- 
priate planetary  influence.  The  moon  was  supposed 
to  rule  the  brain,  Mars  the  bile,  Saturn  the  spleen, 
etc.  Moreover,  since  among  the  Babylonians  from 
the  very  remotest  times  the  sun,  moon,  and  the  five 


86       THE  HISTORY  OF  MEDICINE 

known  planets  were  supposed  to  be  in  some  intimate 
relation  with  the  seven  known  metals,  there  is  a 
natural  connection  between  astrology  and  alchemy, 
or  the  transmutation  of  metals.  The  latter  owes  its 
real  beginnings,  however,  to  the  art  of  dyeing  as 
practiced  by  the  Egyptian  priests.  It  was  found 
possible  to  color  gold,  silver,  electrum,  and  other 
metals  and  alloys,  and,  nothing  being  known  at 
that  time  of  the  actual  chemical  composition  of 
substances,  the  metal's  susceptibility  to  a  certain 
dye  (Tyrian  purple  in  the  case  of  gold)  was  taken 
as  an  index  of  its  purity.  Greek  philosophy  coming 
to  the  aid  of  Egyptian  practice  in  Alexandria 
taught  that  the  baser  metals,  copper  and  lead,  par- 
took of  the  nature  of  earth,  that  tin  and  mercury 
were  of  a  watery  constitution,  that  silver  and  gold 
were  clear  like  air,  while  pure  gold,  the  penetrative 
spirit  or  essence  of  gold,  acted  on  the  other  metals 
like  a  purifying  fire.  Like  a  ferment  it  was  able  to 
transmute  a  mass  of  base  metal  millions  of  times 
greater  than  itself;  like  a  medicine  it  brought  health 
to  the  diseased  or  less  perfect  copper,  lead,  tin,  etc. 
By  the  twelfth  century  this  transforming  essence  was 
called  the  philosopher's  stone,  because  of  its  re- 
sistance to  all  destructive  forces,  and  later  elixir, 
and  it  was  supposed  to  be  possessed  of  wonderful 
healing  power. 

Geber,  who  lived  and  wrote  in  the  eighth  century, 


MEDICAL  SCIENCE  OF  THE  ARABS    87 

has  been  erroneously  called  the  founder  of  alchemy. 
His  authentic  writings  show  a  more  definite  knowl- 
edge of  the  technique  of  chemistry  —  sublimation, 
calcination,  distillation,  filtration,  crystallization, 
the  coupellation  of  metals,  the  use  of  the  water- 
bath,  etc.,  than  found  expression  in  earlier  work. 
Geber  and  his  followers,  among  whom  Rhazes, 
Avicenna,  and  a  number  of  Arab  physicians  are 
counted,  are  credited  with  the  discovery  of  aqua 
fortis,  oil  of  vitriol,  aqua  regia,  lunar  caustic,  corro- 
sive sublimate,  ammonium  chloride,  aqua  vitae. 
They  were  acquainted  with  sulphur,  carbonate  of 
soda,  alum,  borax,  copperas,  pearlash,  arsenic, 
cinnabar,  etc.  Geber  like  Avicenna  discouraged  the 
belief  in  astrology,  denying  the  influence  of  the 
stars  on  the  formation  of  the  metals;  but  it  would  be 
a  mistake  to  ignore  the  influence  of  alchemy  on  the 
chemistry  of  the  eighth  and  the  succeeding  cen- 
turies. The  discovery  of  aqua  regia,  so  called  be- 
cause it  dissolved  gold,  the  king  of  metals,  no  doubt 
found  its  motive  in  the  desire  to  obtain  in  aurum 
potabile  a  sovereign  remedy.  Though  Avicenna 
I  doubted  the  power  of  art  to  transmute  a  metal  from 
the  form  given  it  by  nature,  he  named  as  four 
mineral  spirits  sulphur,  arsenic,  sal  ammoniac,  and 
mercury,  three  of  which  substances  had  been  em- 
ployed in  the  Alexandrian  art  of  coloring  metals. 
This  teaching  was  combined  with  that  of  Rhazes, 


88       THE  HISTORY  OF  MEDICINE 

that  the  metals  are  condensed  vapors,  in  the  six- 
teenth-century doctrine  that  three  invisible  sub- 
stances, sulphur,  mercury,  and  salt,  by  their 
coagulation  form  physical  bodies.  Even  at  the 
present  time  some  trace  of  the  two  pseudo-sciences, 
alchemy  and  astrology,  remains  in  our  use  of  the 
terms  spirits  of  wine,  spirits  of  nitre,  tincture, 
martian  preparations,  saturnine  compounds,  lunar 
caustic,  jovial  disposition,  etc. 

The  pharmacy  of  the  Arabs,  interrelated  with 
their  chemistry  and  botany,  in  the  early  centuries 
of  Mohammedan  civilization  had  already  made  a 
considerable  advance.  It  is  at  this  period  that  we 
first  hear  of  trade  in  drugs,  developed  from  trade  in 
spices,  as  a  distinct  vocation.  The  father  of  Honain, 
as  well  as  the  founder  of  the  fortunes  of  the  Messua 
family,  was  an  apothecary.  As  early  as  the  eighth 
century  public  pharmacies  were  established  at 
Gondisapor  and  at  Bagdad.  The  Arabs  derived  a 
knowledge  of  drugs  from  the  Egyptians,  the  Hindus, 
and  even  more  remote  peoples  with  whom  they 
came  into  commercial  relations.  They  translated 
Dioscorides  and  knew  of  the  Greek  in  addition  to 
the  Indian  means  of  producing  anaesthesia.  Before 
the  end  of  the  ninth  century  the  first  pharmaco- 
poeia had  issued  from  the  hospital  at  Gondisapor. 
We  have  already  noted  an  inclination  among  the 
great  Persian  physicians  to  experiment  on  the 


MEDICAL  SCIENCE  OF  THE  ARABS    89 

effects  of  drugs.  Isaac  Judaeus  advocated  care  and 
restraint  in  the  use  of  remedies.  Moses  Maimonides, 
as  already  implied,  showed  the  interest  of  his  time 
in  the  study  of  toxicology.  Avenzoar  excelled  in  a 
knowledge  of  drugs,  and  was  opposed  to  the  use  of 
purgatives,  but  showed  himself  rather  credulous  in 
reference  to  the  virtues  of  the  smaragdus,  bezoars, 
theriacs,  and  mithridates.  Very  important  in  the 
history  of  materia  medica  are  the  Latin  writings  of 
the  tenth  or  eleventh  century  attributed  to  Messua 
the  Younger,  which  went  through  numerous  edi- 
tions and  formed  the  basis  of  the  European  pharma- 
copoeias. The  work  issued  somewhat  later  under  the 
name  of  Serapion  the  Younger  was  also  a  very  in- 
fluential book  of  doubtful  authenticity.  The  most 
extensive  work  in  Arabic  on  materia  medica  was 
that  written  by  Ibn  Baitar  in  the  thirteenth  cen- 
tury, who  describes  some  four  thousand  drugs  and 
draws  his  material  from  Dioscorides,  Galen,  and 
earlier  Arab  writers  and  supplements  it  with  his 
own  observations.  Senna,  and  other  mild  aperients, 
orange,  lemon,  tragacanth,  and  other  adjuvants, 
syrups,  juleps,  robs,  and  other  methods  of  admin- 
istration, alcohol,  and  other  products  of  distillation, 
were  known  throughout  Europe  from  the  Arab 
treatises  on  pharmacy.  Besides  the  drugs  already 
mentioned,  the  following  became  widely  used  owing 
to  the  influence  of  the  Arabs:  aconite,  aloes,  amber- 


90       THE  HISTORY  OF  MEDICINE 

gris,  camphor,  cannabis  indica,  cloves,  cubebs,  gold, 
manna,  mercury,  musk,  nutmeg,  prunes,  tamarind, 
violet-root,  rose-water,  sandal  wood,  etc. 

Arab  institutions  for  the  care  of  the  sick  were 
modeled  after  the  infirmaries  and  hospitals  of  other 
nations.  Besides  the  temples  of  health  the  Greeks 
had  had  public  iatreia,  difficult  to  distinguish  from 
hospitals.  Infirmaries  for  the  indigent  had  existed 
in  India  and  Ceylon  for  centuries  before  the  be- 
ginning of  the  Christian  era.  The  Romans  provided 
valetudinaria  for  slaves  and  for  soldiers.  At  Edessa 
in  372  a  hospital  of  three  hundred  beds  was  estab- 
lished under  Christian  auspices,  and  to  this  were 
added  in  the  following  century  a  hospital  for  women 
and  a  school  of  medicine.  The  Nestorians,  who  for 
a  time  controlled  these  institutions,  were  compelled 
in  489  to  take  refuge  in  Persia.  Shortly  after  their 
arrival  in  Persia  the  Nestorians,  as  we  have  already 
seen,  were  engaged  in  the  teaching  of  medicine  in 
the  school  and  hospital  at  Gondisapor.  The  latter 
became  the  model  of  institutions  founded  by  the 
Arabs  in  more  than  twenty  of  their  cities.  The  first 
of  these  was  established  at  Damascus  in  707.  Spe- 
cial provision  was  there  made  for  the  care  of  lepers 
and  the  blind.  Before  the  middle  of  the  ninth  cen- 
tury, Bagdad  had  a  hospital  of  which  Messua  the 
Elder  became  director,  and  numerous  other  hospi- 
tals arose  in  that  city  in  the  subsequent  centuries, 


MEDICAL  SCIENCE  OF  THE  ARABS    91 

and  with  one  of  these  the  great  Rhazes  was  asso- 
ciated, as  we  have  seen.  The  most  famous  of  the 
Arab  hospitals  were  the  hospital  founded  at  Damas- 
cus about  1 1 60  by  Nureddin,  as  a  thank-offering  for 
the  deliverance  of  Islam  from  the  menace  of  the 
Second  Crusade,  and  the  Mansur  Hospital  of  Cairo, 
erected  (1284)  for  rulers  and  subjects,  freemen  and 
slaves,  rich  and  poor,  men  and  women.  At  Damas- 
cus, Bagdad,  and  Cairo,  provision  was  made  for 
medical  education,  libraries  were  established,  and 
courses  of  public  lectures  were  given.  The  knowl- 
edge of  ophthalmology  was  particularly  advanced, 
and  the  insane  were  treated  with  much  more  con- 
sideration by  the  Arabs  than  by  the  Christians  of 
the  same  period.  In  the  Western  Caliphate  there 
were  numerous  hospitals  in  Cordova  and  other 
cities.  In  the  twelfth  century  Avenzoar  was  superin- 
tendent of  a  hospital  at  Seville. 

It  is  true  that  the  Arabs  contributed  little  to  the 
advance  of  anatomy,  for  their  beliefs  made  dis- 
section a  forbidden  practice.  They  believed  that  in 
the  world  to  come  the  body  must  be  subjected  to  the 
examination  of  two  angels,  and  that  the  absence  of 
any  part  might  endanger  the  eternal  happiness  of 
the  person.  Moreover,  they  held  that  death  was  a 
gradual  process  only  complete  with  putrefaction, 
and  that  contact  with  a  dead  body  was  a  contami- 
nation. Nevertheless,  though  it  was  left  for  the  age 


92  THE  HISTORY  OF  MEDICINE 

following  that  of  the  dominance  of  the  Arabs  to 
build  upon  the  foundations  laid  by  the  ancients  in 
the  department  of  anatomy,  in  this  field  also  there 
is  evidence  of  the  transmission  of  medical  science 
through  the  channel  of  Arabic  literature.  When  we 
use  the  terms  ligamentum  nuchae,  sagittal  suture, 
dura  mater,  pia  mater,  infundibulum,  or  speak  of 
the  cochlea  of  the  ear,  or  the  auricles  of  the  heart, 
we  adopt  a  nomenclature  suggested  by  the  writings 
of  Arab  physicians,  just  as  when  we  use  the  terms 
Adam's  apple,  and  cauda  equina,  we  follow  the 
figurative  mode  of  expression  of  the  Jewish  physi- 
cians, associated  at  times,  as  we  have  seen,  with  the 
Arabs. 

REFERENCES 
Arabian  Nights,  translated  by  Sir  R.  F.  Burton  In  twelve  volumes. 

London,  1804.    Vol.  iv,  pp.  171-80. 
Berthelot,  M.:  Introduction  a  I' etude  de  la  chimie  des  anciens  et  du 

moyen  dge.    Paris,  1899.    330  pp.;  Les  origines  de  I'alchimie. 

Paris,  1885.    445  pp. 

Browne,  E.  G.:  Arabian  Medicine.  Cambridge,  1921.     139  pp. 
Cholmeley,  H.  P.:    John  of  Gaddesden  and  the  Rosa  Medicines. 

Oxford,  Clarendon  Press,  1912.     184  pp. 
Greenhill,  W.  A.:  A  Treatise  on  the  Smallpox  and  Measles.    By 

Abu    Beer  Mohammed    ibn    Zacariya  Ar-razi    (commonly 

called  Rhazes).  Translated  from  the  Original  Arabic.   Lon- 
don, The  Sydenham  Society,  1848.    212  pp. 
Hopkins,  A.  J.:  "Earliest  Alchemy,"  The  Scientific  Monthly,  June, 

1918,  pp.  530-37. 
Hyrtl,  Joseph:   Das  Arabische  und  Hebraische  in  der  Anatomie. 

Vienna,  1879.    311  pp. 
Levy,  Reuben:  "The  'Tractatus  de  Causis  et  Tndiciis  Morborum,' 

Attributed  to  Maimonides,"  p.  225  in  Studies  in  the  History 


MEDICAL  SCIENCE  OF  THE  ARABS    93 

and  Method  of  Science,  edited  by  Charles  Singer.    Oxford, 

Clarendon  Press,  1917. 
Spencer,  Dr.  Herbert:  "  Mercurio's  or  Watcher's  Position,"  Lancet, 

1912,  vol.  I,  pp.  1568-69. 
Jewish  Encyclopedia:  "Moses  ben  Maimon,"  "Medicine,"  etc. 


CHAPTER  V 

THE  REVIVAL  OF  ANATOMY  AND  SURGERY 
IN  THE  SIXTEENTH  CENTURY 

THE  rise  of  modern  anatomy  and  surgery  is  closely 
associated  with  the  development  of  the  Italian  and 
French  universities.  Southern  Italy  was  the  natural 
meeting-place  of  the  influences  that  contributed  to 
the  growth  of  medical  science  in  the  eleventh, 
twelfth,  and  thirteenth  centuries,  and  the  tradition 
that  the  University  of  Salerno  owed  its  origin  to  the 
combined  efforts  of  an  Arab,  a  Jew,  a  Greek,  and  a 
Roman,  may  be  accepted  as  indicating  the  sources 
from  which  the  Salernitan  teachers  of  medicine  de- 
rived their  doctrines.  Much  of  the  teaching  in  the 
"civitas  Hippocratica,"  as  Salerno  was  called,  re- 
lated to  diet  and  other  matters  of  hygiene,  but 
anatomy  and  surgery  were  by  no  means  overlooked. 
One  of  the  earlier  teachers  at  Salerno,  Copho  the 
Younger,  a  Jew,  was  the  author  of  "De  Anatome 
Porci,"  the  first  modern  work  on  anatomy  (about 
noo).  Toward  the  close  of  the  twelfth  century, 
another  of  the  Salernitan  doctors,  Roger  of  Palermo, 
wrote  a  treatise  on  surgery,  "  Practica,"  which  was 
revised  by  his  pupil  Roland  of  Parma  in  the  thir- 
teenth century.  In  the  section  dealing  with  wounds 


THE  SIXTEENTH  CENTURY        95 

of  the  intestines,  the  surgeon  is  directed  to  insert  in 
the  intestinal  canal  a  small  tubular  piece  of  elder 
and  then  to  stitch  the  raw  edges  of  the  bowel  to- 
gether over  it.  In  the  school  of  Salerno  women  were 
admitted  both  as  students  and  teachers,  and  one 
of  them,  Mercuriada,  wrote  a  treatise  on  surgery. 
Nicholas  of  Salerno,  in  his  "Antidotarium,"  speaks 
of  a  soporific  sponge,  prepared  by  saturating  a 
natural  sponge  with  a  solution  of  mandragora, 
opium,  hyoscyamus,  lettuce,  camphor,  and  nenu- 
phar. This  anodyne  was  dried,  kept  till  needed,  and 
then  moistened  with  hot  water  or  steam,  and  held 
to  the  patient's  nostrils  till  sleep  was  induced. 

Bologna,  the  second  of  the  European  universities, 
contributed  to  the  advance  of  surgery  and  anatomy 
through  the  work  of  Hugh  of  Lucca,  his  son  Theo- 
doric, Bishop  of  Cervia,  William  of  Saliceto,  Mon- 
dino,  and  his  pupil  Bertuccio.  Hugh  of  Lucca,  who 
is  known  to  us  through  the  writings  of  Theodoric, 
was  appointed  city  surgeon  of  Bologna  in  1214,  a 
few  years  later  had  experience  of  military  surgery 
with  the  Crusaders  in  Egypt  and  Syria,  and  died  at 
an  advanced  age  about  the  middle  of  the  thirteenth 
century.  He  observed  strict  cleanliness  in  the  treat- 
ment of  wounds,  avoided  the  use  of  the  probe,  and 
employed  compresses  soaked  in  wine.  Theodoric  is 
quite  definite  concerning  the  advance  made  at 
Bologna  in  surgery.  "For,"  he  states,  "it  is  not 


96       THE  HISTORY  OF  MEDICINE 

necessary,  as  Roger  and  Roland  have  written,  as 
many  of  their  disciples  teach,  and  as  all  modern 
surgeons  profess,  that  pus  should  be  generated  in 
wounds.  No  error  can  be  greater  than  this.  Such  a 
practice  is  indeed  to  hinder  nature,  to  prolong  the 
disease,  and  to  prevent  the  conglutination  and 
consolidation  of  the  wound."  Both  Hugh  and 
Theodoric  made  use  of  anaesthetic  sponges  similar 
to  those  described  by  Nicholas  of  Salerno.  William 
of  Saliceto  (1201-1277)  was,  however,  the  greatest 
surgeon  of  the  thirteenth  century,  and  the  author  of 
a  systematic  work  on  surgery  ("Cyrurgia").  Like 
Hugh  of  Lucca  he  had  had  experience  on  the  field  of 
battle.  He  described  wounds  of  various  kinds,  the 
suturing  of  intestines  and  nerves,  the  treatment  of 
fractures  and  dislocations.  His  influence  tended  to 
restore  the  use  of  the  knife  in  surgery,  though  he 
devoted  considerable  space  to  the  discussion  of 
different  methods  of  cauterization.  Saliceto  dis- 
tinguished between  haemorrhage  from  arteries  and 
veins,  but  his  knowledge  of  anatomy  was,  like  that 
of  all  his  contemporaries,  very  limited. 

The  practice  of  human  dissection,  which  had  been 
held  in  abeyance  by  the  force  of  traditional  senti- 
ment and  religious  prejudice  from  the  third  century 
B.C.  was  indeed  resumed  to  a  certain  extent  in  the 
thirteenth  century,  but  it  was  not  till  1316  that  a 
treatise  on  anatomy  written  by  one  who  had  dis- 


THE  SIXTEENTH  CENTURY       97 

sected  the  human  cadaver  made  its  appearance. 
This  was  the  work  of  Mondino  ("De  omnibus 
humani  corporis  interioribus  membris  Anathomia"), 
who  had  made  numerous  dissections,  two  of  which 
(January  and  March,  1315)  are  particularly  men- 
tioned. In  the  work  of  dissection,  Mondino  was 
aided  by  an  able  prosector,  Otto  Agenius  Lustro- 
lanus,  and  a  devoted  girl  disciple,  Alexandra  Galiani. 
It  is  further  evidence  of  the  enthusiasm  for  dissec- 
tion in  the  University  of  Bologna  at  the  beginning 
of  the  fourteenth  century  that  three  years  after  the 
appearance  of  the  "Anathomia"  four  students  were 
brought  to  trial  for  having  carried  off  by  night  the 
body  of  a  criminal,  which  they  and  others  of  their 
kind  were  intent  upon  dissecting. 

Peter  of  Abano,  a  friend  of  Mondino's  and  also  a 
dissector,  but  much  better  known  as  an  exponent  of 
the  philosophy  of  Averroes  than  as  an  anatomist, 
taught  at  the  University  of  Padua;  while  Arnold  of 
Villanova,  who  wrote  on  surgery  as  well  as  on 
alchemy  and  general  medicine  and,  like  Peter  of 
Abano,  was  accused  of  heresy,  stood  associated  with 
the  famous  school  of  Montpellier.  More  important 
than  either  of  these  from  our  present  point  of  view 
was  Lanfranchi,  a  third  contemporary  of  Mondino's 
and  a  pupil  of  Saliceto's,  who,  about  the  close  of  the 
thirteenth  century,  carried  to  Lyons  and  to  the  Col- 
lege of  Saint  Come  at  Paris  the  teaching  and  prac- 


98       THE  HISTORY  OF  MEDICINE 

tice  of  Bolognese  surgery.  He  was  the  author  of  two 
works  on  surgery  ("Chirurgia  Parva"  and  "Chi- 
rurgia  Magna"),  and,  like  his  master,  protested 
against  the  tendency  to  fix  a  line  between  the  func- 
tion of  the  surgeon  and  the  function  of  the  physi- 
cian, and  between  practice  and  theory.  Lanfranchi 
gave  a  good  account  of  the  symptoms  of  fracture  of 
the  skull,  and  was  the  first  to  describe  concussion 
of  the  brain.  He  recommended  ligature  among 
the  means  of  arresting  haemorrhage,  held  that  ex- 
posure to  the  air  favors  the  formation  of  pus  in 
wounds,  and  advised  neurotomy  in  cases  of  trau- 
matic tetanus.  Henri  de  Mondeville,  the  pupil  of 
Lanfranchi  and  Theodoric,  who  studied  at  Mont- 
pellier  as  well  as  at  Paris  and  Bologna,  aided  in  the 
introduction  of  Italian  methods  of  surgery  into  the 
French  schools.  He  was  the  physician  of  Philip  the 
Fair  and  frequently  attended  that  monarch  and  the 
Count  of  Valois  during  their  military  campaigns. 
Mondeville  lectured  on  anatomy  at  the  University 
of  Montpellier  in  1304,  and  set  forth  views  of  the 
structure  and  function  of  the  body  strongly  remi- 
niscent of  the  teachings  of  Galen  and  the  nomen- 
clature of  the  Arabs.  His  surgery,  however,  showed 
the  influence  of  his  Italian  masters  and  contem- 
poraries. "Many  more  surgeons,"  he  remarks  with 
characteristic  incisiveness,  "know  how  to  cause 
suppuration  than  to  heal  a  wound." 


THE  SIXTEENTH  CENTURY        99 

Guy  de  Chauliac  (1300-70)  was  the  greatest 
surgeon  of  the  fourteenth  century.  The  son  of 
humble  country  people  of  the  French  province  of 
Auvergne,  he  studied  at  Toulouse,  Montpellier, 
Paris,  and  Bologna.  He  learned  anatomy  from 
Bertruccio,  who  taught  dissection  in  four  sessions 
devoted  to  the  abdomen,  thorax,  head,  and  extremi- 
ties, and  made  use  of  dried  specimens  and  bones 
prepared  by  boiling.  De  Chauliac  was  also  in- 
debted to  certain  anatomical  illustrations  (eighteen) 
of  Mondeville's.  The  "Chirurgia  Magna"  (1363), 
one  of  the  greatest  contributions  to  the  development 
of  surgery,  shows  that  Guy  de  Chauliac  was  ac- 
quainted with  medical  history  from  the  time  of 
Hippocrates,  and  was  under  special  obligation  to 
Galen,  Avicenna,  Albucasis,  and  other  Arabic  writ- 
ers, as  well  as  to  his  immediate  predecessors  in  the 
French  and  Italian  universities.  At  the  same  time 
his  extensive  knowledge  of  the  practice  and  theory 
of  others  did  not  deprive  him  of  independence 
and  self-confidence.  "For,"  he  said,  "we  are  like 
children  astride  the  neck  of  a  giant,  who  see  all  the 
giant  sees  and  something  besides."  In  cases  of 
fracture  of  the  femur,  in  addition  to  splints  reaching 
to  the  foot  he  employed  a  box  or  trusses  of  straw  to 
support  the  limb  and  attached  to  the  foot  a  lead 
weight  by  means  of  a  cord  passing  over  a  little 
pulley.  He  followed  Theodoric  and  others  in  using 


ioo     THE  HISTORY  OF  MEDICINE 

>^,         „       . 

narcotic  inhalations  to  produce  insensibility  to  pain, 
but  adopted  the  theory  of  coction  of  irritant  humors 
and  laudable  pus  in  the  treatment  of  wounds.  Like 
Salicetoihe  believed  in  restricting  the  use  of  the 
actual  cautery,  and  advocated  a  close  alliance  be- 
tween surgery  and  medicine.  He  taught  that  cancer 
should  be  treated  at  an  early  stage  and  preferably 
with  the  knife;  he  gave  directions  for  complete 
ablation  of  the  gland  in  case  of  adenitis,  and  for 
suturing  the  intestines;  he  made  use  of  the  speculum 
in  certain  obstetrical  operations;  he  gave  an  account 
of  the  Caesarean  operation  following  the  death  of  the 
mother. ,  True  to  his  own  principles  he  did  not  con- 
fine his  attention  to  surgery,  but  gained  acquaint- 
ance with  all  the  medical  science  of  his  time.  He 
introduced  the  use  of  sugar  in  medicinal  prepara- 
tions, and  gave  a  careful  description  of  the  symp- 
toms of  leprosy  to  prevent  the  isolation  of  patients 
unjustly  suspected  of  being  lepers  and  to  protect 
the  general  public  against  Contagion.  Much  of  Guy 
de  Chauliac's  life  was  passed  at  Avignon  where  he 
was  the  physician  of  Pope  Clement  VI  and  his 
successors.  In  the  Black  Death  epidemics  of  1348 
and  1360  he  took  part  in  combating  the  pestilence,  • 
of  the  different  forms  of  which  he  has  left  descrip- T 
tions.  Some  of  the  manuscripts  of  the  "Chirurgia 
Magna"  contain  illustrations  of  the  opening  of 
inguinal  and  axillary  abscesses,  of  venesection,  of 


101 

the  application  of  the  (Gooch)  splint,  of  instru- 
ments for  trepanning  (borers,  elevators,  rugines, 
etc.),  for  fistula  operation,  and  for  cauterization 
(olivary,  dactillary,  punctuale,  etc.). 

In  spite  of  the  foundations  laid  in  anatomy  by 
Mondino  and  in  surgery  by  Guy  de  Chauliac  and 
by  the  other  anatomists  and  surgeons  trained  at  the 
French  and  Italian  universities,  the  general  Euro- 
pean practitioner  of  the  fourteenth  century  no 
doubt  deserved  the  satire  leveled  at  him  by  the 
English  poet  Chaucer  a  few  years  after  the  death  of 
Guy  de  Chauliac.  Lines  5-8  in  the  following  quota- 
tion are  rather  obscure,  but  refer  to  the  attempts  of 
the  medical  astrologers  to  bring  magic  influence  to 
bear  by  means  of  diagrams  of  constellations  made  at 
the  proper  astrological  moment.  Such  diagrams  or 
images  were  frequently  engraved  on  gems  and  were 
supposed  to  accumulate  influence. 

»       With  us  ther  was  a  Doctour  of  Phisyk, 
In  al  this  world  ne  was  ther  noon  him  lyk 
To  speke  of  phisik  and  of  surgerye; 
For  he  was  grounded  in  astronomye. 
He  kepte  his  pacient  a  ful  greet  del 
In  houres  by  his  magik  naturel. 
Wei  coude  he  fortunen  the  ascendent 
Of  his  images  for  his  pacient. 
He  knew  the  cause  of  everich  maladye, 
Were  it  of  hoot  or  cold,  or  moiste,  or  drye, 
And  where  engendred,  and  of  what  humour; 


:-u 
,02     THE  HISTORY  OF  MEDICINE 

He  was  a  verrey  parfit  practisour. 

The  cause  y-knowe,  and  of  his  harm  the  rote, 

Anon  he  yaf  the  seke  man  his  bote  [remedy]. 

Ful  redy  hadde  he  his  apothecaries, 

To  send  him  drogges  and  his  letuaries, 

For  ech  of  hem  made  other  for  to  winne, 

Hir  frendschipe  nas  not  newe  to  beginne. 

Wei  knew  he  the  olde  Esculapius, 

And  Deiscorides,  and  eek  Rufus, 

Old  Ypocras,  Haly,  and  Galien, 

Serapion,  Razis,  and  Avicen, 

Averrois,  Damascien,  and  Constantyn, 

Bernard,  and  Gatesden,  and  Gilbertyn. 

Of  his  diete  mesurable  was  he, 

For  it  was  of  no  superfluitee, 

But  of  great  norissing  and  digestible. 

His  studie  was  but  litel  on  the  Bible. 

In  sangwin  and  in  pers  he  clad  was  al, 

Lyned  with  taffata  and  with  sendal; 

And  yet  he  was  but  esy  of  dispence; 

He  kepte  that  he  won  in  pestilence. 

For  gold  in  phisik  is  a  cordial, 

Ther  fore  he  lovede  gold  in  special. 

In  Germany  the  universities  were  particularly 
late  in  providing  instruction  in  medicine,  and  the 
first  celebrated  German  surgeons  acquired  their 
skill  on  the  field  of  battle.  Pfolspeundt,  a  Bavarian 
army  surgeon  of  the  fifteenth  century,  mentions 
incidentally  the  treatment  of  gunshot  wounds 
(1460).  Speaking  of  the  more  familiar  arrow  wounds, 
he  says,  in  the  spirit  of  Chaucer's  Doctour,  that 


THE  SIXTEENTH  CENTURY      103 

recovery  depends  on  the  favorable  conjunction  of 
the  planet  that  is  in  the  ascendant.  His  knowledge 
of  rhinoplasty  and  his  use  of  a  narcotic  inhalation 
show  that  he  was  somewhat  influenced  by  Italian 
surgeons.  Hieronymus  Brunschwig,  an  Alsatian 
army  surgeon,  born  at  Strassburg  in  the  early  part 
of  the  fifteenth  century,  wrote  as  an  old  man  "Das 
Buch  der  Wund-Artzney "  (1497).  He  held  that 
gunshot  wounds  are  poisoned  and  that  suppuration 
should  be  induced  as  a  means  of  purification.  He 
was  acquainted  with  the  work  of  the  leading  French 
and  Italian  surgeons.  Hans  von  Gersdorff,  also  a 
native  of  Strassburg,  gained  experience  of  military 
surgery  in  the  campaigns  of  Charles  the  Bold  and 
was  present  at  the  battles  of  Granson  (1476)  and 
Nancy  (1477).  He  wrote  a  "  Feldtbuch  der  Wundt- 
artzney"  (1517)  illustrated,  like  Brunschwig's  work, 
with  excellent  woodcuts.  He  performed  about  two 
hundred  amputations,  and  developed  a  method  of 
his  own.  He  did  not  believe  that  gunshot  wounds 
are  necessarily  poisoned,  but  in  certain  cases  fol- 
lowed the  practice  of  pouring  hot  oil  into  the 
wounds.  Giovanni  da  Vigo,  in  the  "Practica  Cop- 
iosa"  (1514),  had  taught,  according  to  Pare,  "that 
wounds  made  by  firearms  partake  of  venenosity, 
by  reason  of  the  powder;  and  for  their  cure  he  bids 
you  cauterize  them  with  oil  of  elder-flowers  scalding 
hot,  mixed  with  a  little  treacle." 


104     THE  HISTORY  OF  MEDICINE 

In  the  meantime  anatomy  had  made  a  great  ad- 
vance in  Italy  under  the  influence  of  the  Renais- 
sance spirit.  The  practice  of  dissection,  which  had 
gained  a  definite  place  in  medical  education  through 
the  efforts  of  Mondino,  was  continued  at  Bologna, 
Padua,  and  other  Italian  universities  by  Zerbi, 
Achillini,  and  Marc  Antonio  della  Torre  in  the 
brilliant  period  of  scientific  and  artistic  activity  at 
the  close  of  the  fifteenth  and  the  beginning  of  the 
sixteenth  century.  The  greatest  contribution,  how- 
ever, to  the  advancement  of  the  study  of  anatomy 
was  made  by  the  supreme  genius  of  the  time, 
Leonardo  da  Vinci,  1452-1519,  who  has  been  de- 
scribed as  a  painter,  sculptor,  architect,  engineer, 
musician,  poet,  philosopher,  chemist,  botanist,  and 
geologist,  and,  in  addition  was  referred  to  by 
William  Hunter  as  the  very  best  anatomist  and 
physiologist  of  his  time.  We  learn  from  an  Italian 
painter  and  writer  of  the  sixteenth  century  (Vasari) 
that  Leonardo  "filled  a  book  with  drawings  in  red 
crayon  outlined  with  a  pen,  all  the  copies  made 
with  the  utmost  care  [from  bodies]  dissected  by  his 
own  hand.  In  this  book  he  set  forth  the  entire 
structure,  arrangement  and  disposition  of  the 
bones,  to  .which  he  afterwards  added  all  the  liga- 
ments, in  their  due  order,  and  next  supplied  the 
muscles.  Of  each  separate  part  he  wrote  an  explana- 
tion in  rude  characters  written  backward?  and  with 


,-  -.'••••  -n-  < -"/ -•  -arflt'^Cs'iV»7V7l ?/jP 

:,^^r/       •  .       ?rasRSS3F5 

v  flwSftw^ 


.  .-..i.  , 


DISSECTION  SHOWING  THE  FEMALE  VISCERA  IN  SITU 
Drawn  by  Leonardo  da  Vinci,  circa  1510 


THE  SIXTEENTH  CENTURY       105 

the  left  hand,  so  that  whoever  is  not  practiced  in 
writing,  cannot  understand  them,  since  they  are 
only  to  be  read  with  a  mirror."  These  invaluable 
anatomical  drawings  are  still  preserved,  and  within 
the  last  twenty-five  years  have  been  made  accessible 
in  a  series  of  splendid  reproductions. 

Leonardo  thus  affords  us  one  of  the  finest  ex- 
amples of  the  mutual  influence  of  art  and  medical 
science.  The  Greek  sculptors,  taught  by  the  ob- 
servation of  naked  youth  in  the  palaestra  and 
gymnasium,  had  depicted  the  human  form  with 
remarkable  fidelity,  even  exhibiting  in  their  statues 
the  contours  of  the  pectineus  muscle  as  developed 
by  gymnastic  exercises.  For  the  intuitions  of  Greek 
artistic  genius  Leonardo  did  not  disdain  to  sub- 
stitute scientific  observation  based  on  the  dissection 
of  more  than  thirty  bodies  of  men  and  women.  He 
studied  human  development  and  deterioration, 
measured  the  proportions  of  the  skeleton,  and  com- 
pared with  the  human  foot  the  foot  of  the  bear,  the 
ape,  and  the  bird.  He  analyzed  the  play  of  the 
muscles,  the  expression  of  the  emotions,  and  move- 
ment in  general.  He  not  only  pictured  the  muscles 
as  they  appear  to  the  eye  of  the  artist,  but  repre- 
sented them  schematically  by  straight  lines  and 
explained  their  action  as  a  system  of  levers.  Ex- 
plaining the  mechanism  of  respiration,  Leonardo 
states:  "All  these  muscles  serve  to  elevate  the  ribs, 


106     THE  HISTORY  OF  MEDICINE 

and  the  elevation  of  the  ribs  produces  a  dilation  of 
the  chest,  and  the  dilation  of  the  chest  involves  an 
expansion  of  the  lungs  and,  consequently,  an  at- 
traction of  the  air  which  through  the  mouth  enters 
the  lungs  now  increased  in  capacity."  He  did  not 
confine  his  attention  to  the  bones,  ligaments,  and 
muscles,  but  depicted  in  his  seven  hundred  and 
fifty  or  more  sketches,  the  brain,  nerves,  blood- 
vessels, lungs,  gravid  uterus,  heart,  stomach,  etc. 
It  was  Leonardo,  who,  with  an  artist's  confidence 
in  his  own  powers  of  observation,  struck  from  the 
study  of  anatomy  the  fetters  fastened  upon  it  for 
centuries  by  the  authority  of  Galen.  His  influence, 
however,  was  limited  by  his  failure  to  bring  to  com- 
pletion the  projected  work  on  anatomy  for  which  he 
had  made  such  magnificent  preparations.  The 
works  of  Berengario  da  Carpi  (1470-1530),  who 
wrote  extensive  commentaries  on  Mondino,  prove 
that  their  author,  though  a  dissector  and  touched 
by  the  independent  spirit  of  the  Renaissance,  did 
not  stand  altogether  free  from  the  prepossessions  of 
traditional  anatomy.  It  was  reserved  for  the  great 
Vesalius  in  his  systematic  and  well-illustrated  work, 
"De  Humani  Corporis  Fabrica,"  to  bring  that 
anatomy  to  the  test  of  observation. 

Andreas  Vesalius,  born  at  Brussels  December  31, 
1514,  attended  the  University  of  Louvain,  and  in 
1533  studied  anatomy  at  Paris  under  the  Galenist 


THE  SIXTEENTH  CENTURY       107 

Jacques  Dubois  (Jacobus  Sylvius).  Interrupted  in 
his  studies  by  the  wars  between  Francis  I  and  the 
Emperor  Charles  V,  Vesalius  returned  to  Louvain 
in  1536.  In  the  following  year  he  went  to  Venice, 
and  before  the  completion  of  his  twenty-third  year 
received  his  doctor's  degree  at  Padua,  a  city  at  that 
time  controlled  by  the  enlightened  government  of 
the  Venetian  Republic.  In  spite  of  his  youth  he  was 
immediately  appointed  professor  of  surgery.  As- 
suming the  responsibility  of  imparting  a  knowledge 
of  anatomy  to  the  students  of  Padua,  Vesalius  al- 
most at  once  departed  from  the  established  practice 
of  reading  Galen  in  the  lecture  room,  and  directed 
attention  to  what  he  afterwards  referred  to  as  "that 
true  Bible,  as  we  count  it,  of  the  human  body  and 
of  the  nature  of  man."  The  lecturer  became  a 
demonstrator,  appealing  from  the  authority  of 
Galen  to  the  evidence  of  the  senses.  The  chief 
results  of  his  observations  as  a  dissector  are  em- 
bodied in  the  "Fabrica,"  which,  completed  and 
dedicated  to  the  Emperor  in  1542,  was  printed  in 
1543,  in  which  year  also  appeared  the  revolutionary 
work  of  Copernicus.  Discouraged  by  the  opposition 
offered  to  his  expositions  of  the  truth,  Vesalius  re- 
linquished his  professorship  in  the  following  year, 
and  accepted  appointment  as  physician  to  Charles 
V.  On  the  abdication  of  that  monarch,  in  1556, 
Vesalius  became  physician  at  the  court  of  the  son, 


io8     THE  HISTORY  OF  MEDICINE 

Philip  II,  residing  in  Spain  from  1559  till   1563. 
From  Spain  he  went  as  a  pilgrim  to  Jerusalem, 
probably  cherishing  the  hope  of  eventually  resum- 
ing his  activities  as  an  anatomist  at  Padua.   Broken 
in  health,  however,  before  he  had  started  on  his 
pilgrimage,  further  reduced  by  the  privations  of  a 
rough  and  protracted  voyage  as  he  was  returning 
from  the  East,  Vesalius  landed  on  the  desolate 
shore  of  the  island  of  Zante,  and  there  died  in  1564. 
Vesalius  considered  Galen  as  easily  first  among 
the  students  and  teachers  of  dissection  and  as  the 
greatest  physician  after  Hippocrates.    He  followed 
up   Galen's    physiological    experiments   on    living 
animals,    and    even    accepted  —  provisionally    at 
least  —  the  Galenic  theories  of  the  circulation  and 
other  bodily  functions.  He  did  not  fail,  however,  to 
point  out  Galen's  shortcomings,  to  many  of  which 
he,  as  a  dissector  of  lower  animals,  held  the  clue, 
and  he  was  particularly  severe  with  those  disciples 
of  Galen  who  contended  that  the  Galenic  anatomy 
described  man  rather  than  the  ape.  He  showed  that 
Galen  in  his  description  of  the  suture  of  the  frontal 
bone,  of  the  division  of  the  inferior  maxilla,  in  his 
account  of  the  sacrum  and  coccyx,  of  the  lumbar 
and  abdominal  muscles,  of  the  muscles  of  the  leg, 
foot,  and  hand,  as  well  as  in  his  account  of  the 
vascular  system,  had  been  too  much  influenced  by 
observations  made  in  dissecting  apes.    He  showed 


THE  SIXTEENTH  CENTURY       109 

that  the  Galenic  description  of  the  occipital  bone, 
of  the  intestines  in  general,  of  the  caecum  (the  ap- 
pendix of  which  he  knew  to  be  particularly  small  in 
man),  was  borrowed  from  the  anatomy  of  the  dog; 
while  the  structure  of  both  apes  and  dogs  had  vi- 
tiated the  traditional  descriptions  of  the  lumbar 
vertebrae,  the  lungs,  etc.  Deluded  by  the  dissection 
of  oxen,  the  great  anatomist  of  antiquity  had  falsely 
attributed  to  man  a  complex  intracranial  plexus  of 
blood-vessels  (rete  mirdbile) ;  while  his  knowledge  of 
the  uterus  and  of  the  form  of  the  liver  had  also  been 
obtained  by  the  dissection  of  brute  animals. 

Vesalius,  moreover,  corrected  Galen's  account  of 
the  foramina  of  the  skull,  of  the  processes  of  the 
cervical  vertebrae,  of  the  tubercles  of  the  humerus, 
of  the  shafts  of  humerus  and  femur,  of  the  form  and 
consistency  of  the  sphenoid,  of  the  internal  struc- 
ture of  the  phalanges.  The  Galenic  account  of  the 
muscles  and  movements  was  subjected  to  criticism 
—  the  dorsal  as  well  as  the  abdominal  muscles,  the 
movements  of  the  head,  spine,  and  upper  extremity. 
Vesalius  discovered  the  semilunar  cartilages  of  the 
knee-joint,  and  corrected  Galen's  mistakes  in  refer- 
ence to  the  cartilage  of  the  patella,  the  articulations 
of  the  ribs,  and  the  ligaments  of  the  arm.  Vesalius 
gave  a  better  description  of  the  brain  than  had 
been  given  before  his  time,  discovered  the  inferior 
longitudinal  sinus,  described  the  septum  lucid  urn, 


I  io     THE  HISTORY  OF  MEDICINE 

pointed  out  Galen's  inconsistencies  in  reference  to 
the  ventricles,  called  in  question  his  account  of  the 
meninges,  and  of  the  structure  and  functions  of  the 
nerves.  He  showed  the  defects  in  Galen's  descrip- 
tion of  the  veins  of  the  upper  arm  and  axilla, 
mesentery  and  intestines,  and  claimed  that  Galen 
had  been  unduly  influenced  by  Aristotle  in  reference 
to  the  vena  cava,  and  the  structure  of  the  heart. 
The  attempt  of  Vesalius  to  accommodate  his  state- 
ments to  Galen's  physiological  doctrines  did  not 
blind  him  to  the  fact  that  the  interventricular 
septum  shows  no  visible  perforations.  He  writes: 
"The  septum  of  the  ventricles,  composed  as  I  have 
said  of  the  thickest  substance  of  the  heart,  abounds 
on  both  sides  with  little  pits  impressed  in  it.  Of 
these  pits,  none,  so  far  at  least  as  can  be  perceived 
by  the  senses,  penetrate  through  from  the  right  to 
the  left  ventricle,  so  that  we  are  driven  to  wonder 
at  the  handiwork  of  the  Almighty,  by  means  of 
which  the  blood  sweats  from  the  right  to  the  left 
ventricle  through  passages  which  escape  human 
vision."  In  somewhat  like  spirit  he  treated  the 
questions  of  the  presence  in  man  of  an  indestructible 
resurrection-bone,  the  absence  of  a  creation-rib,  and 
the  position  of  heart  and  umbilicus. 

Among  his  many  other  contributions  to  the  de- 
velopment of  anatomy,  Vesalius  is  to  be  credited 
with  the  discovery  of  the  ductus  venosus,  the  de- 


THE  SIXTEENTH  CENTURY       in 

scription  of  the  vena  azygos,  the  seminiferous  ducts, 
the  internal  pterygoid  and  lingual  muscles,  the 
mediastinum  and  the  pleura,  an  account  of  the 
structure  of  the  pyloris,  liver,  kidney,  and  spleen. 
He  made  post-mortem  examinations,  was  a  success- 
ful surgeon,  and  resisted  the  tendency  to  divorce 
the  study  of  one  branch  of  medical  science  from  an- 
other. His  great  service  was  to  make  anatomy  a  pro- 
gressive study  through  his  comprehensive  volume, 
which  recorded  his  own  observations  and  contained 
illustrations,  probably  reproduced  from  his  own 
drawings,  and  marked  by  a  sense  of  truth  and 
beauty  not  unlike  that  of  Leonardo. 

"Mere  knowledge  without  experience,"  said  Am- 
broise  Pare  (1517-90),  "does  not  give  the  surgeon 
much  self-confidence."  The  rapidly  growing  knowl- 
edge of  anatomy  and  experience  in  the  wars  of 
Francis  I  and  his  successors  combined  in  bringing 
to  perfection  the  powers  of  that  most  illustrious  of 
army  surgeons.  Born  near  Laval  in  Maine,  France, 
Par6  received  early  training  as  a  barber  surgeon, 
and  even  in  his  maturity  he  was  treated  super- 
ciliously, if  not  by  the  surgeons  of  Saint  C6me,  at 
least  by  the  doctors  of  the  Facult6.  Coming  to 
Paris  as  a  youth,  he  continued  his  apprenticeship 
and  served  three  years  as  a  dresser  at  the  H6tel 
Dieu.  He  had  his  first  experience  of  military 
surgery  in  the  Italian  campaign  of  1536,  and  soon 


ii2     THE  HISTORY  OF  MEDICINE 

discarded  Vigo's  boiling-oil  treatment,  and  further 
distinguished  himself  by  an  exarticulation  of  the 
elbow- joint,  the  first  operation  of  the  kind  on 
record.  He  returned  to  Paris  in  1539,  but  his  ser- 
vices as  an  army  surgeon  were  soon  again  in  requisi- 
tion. His  pages  tell  of  the  successful  treatment  of 
wounds  inflicted  by  lance,  sword,  halberd,  stone, 
arquebus,  pistol,  culverin,  and  other  firearms.  His 
treatise,  "La  m£thode  de  traiter  les  plaies,"  ap- 
peared in  1545.  He  studied,  as  opportunity  offered, 
the  works  of  the  great  surgeons,  pursued  anatomy 
under  Sylvius,  prepared  an  epitome  of  the  "Fa- 
brica,"  and  in  1549  produced  an  antomical  treatise. 
In  1552  Par6  amputated  without  cauterization  the 
leg  of  a  gentleman  hit  by  a  cannon-ball.  "  I  dressed 
him,  God  healed  him  (Je  le  pansay,  Dieu  le  guarist). 
I  sent  him  home  merry  with  a  wooden  leg."  His 
example  fully  revived  the  use  of  the  ligature,  and 
placed  further  restrictions  on  the  use  of  the  actual 
cautery.  At  the  close  of  the  same  year  he  smuggled 
into  the  city  of  Metz,  besieged  by  the  Emperor, 
medical  supplies  from  Henry  II,  and  was  welcomed 
by  the  nobles  of  the  garrison,  who  said  that  since 
he  had  arrived  they  would  no  longer  feel  in  danger 
of  dying  in  case  they  should  chance  to  be  wounded. 
Five  years  later,  after  the  battle  of  Saint  Quentin, 
he  was  busy  at  La  Fere-en-Tardenois,  and  found  the 
wounded  particularly  difficult  to  cure.  The  earth 


THE  SIXTEENTH  CENTURY      113 

for  more  than  half  a  league  around  him  was  all 
covered  with  the  dead,  and  so  many  green  and  blue 
flies  arose  from  them  as  to  hide  the  sun.  "It  was 
wonderful,"  he  continues,  "to  hear  them  buzzing; 
and  where  they  settled,  there  they  infected  the  air, 
and  brought  pestilence  with  them."  In  1559  Par6 
was  consulted,  along  with  Vesalius,  in  the  case  of 
Henry  II,  accidentally  wounded  while  tilting.  The 
patient  in  this  case  succumbed  tp  concussion  of  the 
brain.  In  1564  Pare  courageously  fought  at  Paris 
an  epidemic  of  the  plague,  and  published  an  ex- 
tensive work  on  surgery  copiously  illustrated.  In 
1569  we  find  him  successfully  treating  a  nobleman 
near  Mons,  who  had  been  suffering  for  months  from 
a  gunshot  wound  with  fracture  of  the  femur.  In 
addition  to  local  treatment,  Par6,  as  usual,  had 
regard  to  the  general  condition  of  the  injured  man, 
and  advised  the  use  of  a  forehead-cloth  of  oil  of 
roses  and  water-lilies  and  poppies  and  a  little  opium 
and  rose-vinegar.  At  the  same  time  the  patient 
must  be  allowed  to  smell  flowers  of  henbane  and 
other  narcotics. 

Par6  described  various  forms  of  fracture,  including 
fracture  of  the  neck  of  the  femur,  and  fracture  of 
the  parietal  bone  with  extrusion  of  brain  substance ; 
he  invented  arterial  forceps,  many  other  kinds  of 
surgical  instruments,  as  well  as  artificial  limbs, 
artificial  eyes,  and  feeding-bottles;  he  encouraged 


114     THE  HISTORY  OF  MEDICINE 

the  use  of  the  truss,  insisted  that  regular  surgeons 
should  not  abstain  from  the  treatment  of  hernia, 
cataract,  and  stone,  and  followed  the  practice  of  the 
old  French  lithotomists  in  employing  a  grooved 
director;  he  suggested  syphilis  as  a  cause  of  aneur- 
ism and  hypertrophy  of  the  prostate  as  a  cause  of 
strangury;  he  revived  version  by  the  feet,  advocated 
prompt  evacuation  of  the  uterus  in  case  of  haemor- 
rhage during  labor,  and  knew  of  the  possibility  of 
the  Csesarean  operation  during  the  life  of  the  mother; 
he  performed  bronchotomy,  neurotomy,  staphylo- 
plasty,  and  made  use  of  the  figure  8  suture  in  cases 
of  hare-lip;  he  removed  articular  concretions,  re- 
frained from  the  too  frequent  dressing  of  ulcers, 
improved  the  method  of  trepanning,  and  made 
advances  in  eye  surgery.  Like  Guy  de  Chauliac, 
Par£  did  not  confine  his  attention  to  surgery,  but 
wrote  on  various  branches  of  medical  science  and 
insisted  on  isolation  of  those  suffering  from  leprosy. 
The  work  of  the  father  of  modern  surgery  was 
supplemented  by  his  favorite  disciple  Guillemeau, 
by  Rousset,  by  Pierre  Franco,  by  Laurent  Colot, 
by  the  Italian  Tagliacozzi,  and  by  the  naval  and 
military  surgeon  William  Clowes  (1540-1604).  With 
the  father  of  modern  anatomy  must  likewise  be 
mentioned  his  contemporaries  Vidius,  Charles 
Etienne,  the  great  Eustachius  (1524-74),  his  pupils 
Fallopius  and  Columbus,  his  fellow-student  Serve- 


THE  SIXTEENTH  CENTURY       115 

tus,  as  well  as  Ingrassias,  Aranzi,  the  brilliant 
Varolius,  Andrea  Cesalpino,  and  Fabricius  (1537- 
1619),  the  teacher  of  Harvey. 

REFERENCES 

Ball,  James  Moores:  Andreas  Vesalius.  St.  Louis,  1910.  149  pp. 
Heizmann,  Charles  L.:  "Military  Sanitation  in  the  Sixteenth, 

Seventeenth,  and  Eighteenth  Centuries,"  Annals  of  Medical 

History,  pp.  281-300.  •<         •    ;• 
Hopstock,  H.:  "Leonardo  as  Anatomist,"  Studies  in  the  History 

and  Method  of  Science,  pp.  151-91,  Clarendon  Press,  1921. 
Leonardo  da  Vinci:    /  Manoscritli,  edited  by  SabacnikolT  and 

Piumati,  with  French  translation,  and  an  introduction  by 

Professor  Duval.     2  vols.   Paris,  Turin,  1898,  1901. 

Quaderni  d'Anatomia,  edited  by  Vangensten,  Hopstock, 

and    Fonahn,    with    English    and    German    translations. 

Christiania.    6  vols.     1911-16. 
Locy,  W.  A.:  "Anatomical  Illustration  before  Vesalius,"  Journal 

of  Morphology,  Chicago,  1911,  pp.  945-87. 
McMurrich,  J.  P.:  "Leonardo  da  Vinci  and  Vesalius,"  Medical 

Library  and  Historical  Journal,  1906,  pp.  338-50. 
Paget,  Stephen:   Ambroise  Pare  and  his  Times.   London,  1897. 

304  pp. 
Pilcher,  L.  S.:  "The  Mondino  Myth,"  Medical  Library  and 

Historical  Journal,  1906,  pp.  311-31. 
Roth,  M.:  Andreas  Bruxellensis  (in  German).    Berlin,   1892. 

500  pp. 
Singer,  Charles:  "The  Figures  of  the  Bristol  Guy  de  Chauliac 

MS"   (circa   1430),  Proc.   Roy.  Soc.  Med.,   1917,  vol.  x 

(Section,  History  of  Medicine),  pp.  71-90. 

"Thirteenth    Century   Miniatures   illustrating  Medieval 

Practice,"  Proc.  Roy.  Soc.  Med.,  1915,  vol.  ix  (S.  H.  M.), 

pp.  29-42. 
Welch,  W.  H.:  The  Times  of  Vesalius.     Contributions  of  Vesalius 

Other  than  Anatomical.    Johns  Hopkins  Hospital  Bulletin, 

I9I5>  PP-  118-20. 
Vesalius:  De  Humani  Corporis  Fabrica  Libri  Septem,  cum  indice, 

etc.  Venetiis,  1568.  510  pp. 


CHAPTER  VI 

WILLIAM  HARVEY  AND  THE  REVIVAL  OF 
PHYSIOLOGY 

WE  have  seen  in  an  earlier  chapter  the  views  of 
Erasistratus  and  Galen  concerning  the  structure 
and  function  of  the  heart,  the  arteries,  and  the  veins. 
The  advance  in  anatomy  led  by  Vesalius  prepared 
the  way  for  a  further  advance  in  physiology.  His 
careful  study  of  the  structure  of  the  minute  ramifica- 
tions of  the  veins  and  arteries  must  have  brought 
him  to  the  very  threshold  of  the  discovery  of  the 
circulation  of  the  blood,  and  the  second  edition  of 
the  "De  Fabrica"  (1555)  shows  that  he  became 
very  skeptical  concerning  the  passage  of  blood  from 
the  right  to  the  left  ventricle  through  the  septum  of 
the  heart.  His  incredulity  on  this  score  may  have 
been  strengthened  by  the  "  Restitutio  Christianismi " 
of  his  fellow  student  Michael  Servetus,  published 
in  1553.  In  this  book  Servetus  taught  that  the  blood 
—  or,  at  least,  some  of  it  —  passes  from  the  right 
ventricle  to  the  left,  not  through  the  cardiac  septum, 
but  "is  moved  in  a  long  passage  through  the  lungs; 
by  them  it  is  prepared ;  it  is  made  bright ;  it  is  trans- 
fused from  the  arterious  vein  to  the  venous  artery" ; 
in  fact,  that  what  we  call  arterial  blood  is  "a  mix- 


HARVEY  AND  PHYSIOLOGY      117 

ture  made  in  the  lungs  of  the  inhaled  air  with  the 
blood  which  the  right  ventricle  communicates  to 
the  left." 

Before  the  death  of  Vesalius,  Eustachius  de- 
scribed a  large  vessel  extending  downward  from  the 
left  subclavian  vein,  provided  at  its  orifice  with  a 
semicircular  valve,  and  containing  a  scanty,  watery, 
fluid.  The  valves  of  the  veins  were  known  to 
Charles  Etienne,  another  contemporary  of  Vesalius, 
to  their  master,  Jacobus  Sylvius,  to  Cannanus  (in 
1546),  and  other  anatomists.  Fabricius,  the  pupil  of 
Fallopius  and  the  master  of  William  Harvey,  ob- 
served the  valves  of  the  veins  independently  in 
1574,  and  published  an  illustrated  treatise  on  the 
subject  ("De  Venarum  Ostiolis")  the  year  after 
Harvey's  graduation  at  Padua.  Two  other  pre- 
decessors of  Harvey  took  an  honorable  part  in  the 
discovery  of  the  circulation  of  the  blood.  Matheus 
Realdus  Columbus,  who  had  been  the  assistant  and 
successor  of  Vesalius  at  Padua,  became  in  1545  the 
first  professor  of  anatomy  at  the  University  of  Pisa, 
and  in  1548  was  called  to  Rome.  In  the  "De  Re 
Anatomica,"  which  was  published  after  his  death  in 
1559,  Columbus  states  that  "the  blood  is  carried  by 
the  artery-like  vein  to  the  lung  and  being  there 
made  thin  is  brought  back  thence  together  with  air 
by  the  vein-like  artery  to  the  left  ventricle  of  the 
heart."  Harvey  indeed  acknowledged  his  indebted- 


ii8      THE  HISTORY  OF  MEDICINE 

ness  to  Columbus,  "that  skilful  and  learned  anato- 
mist," as  well  as  to  Galen,  for  guidance  in  reference  to 
the  pulmonary  circulation.  Andreas  Caesalpinus, 
1519-1603,  approached  even  more  nearly  the  mod- 
ern explanation  of  the  circulation  of  the  blood.  In 
his  "Quaestiones  Peripateticae  "  (1571)  he  wrote  as 
follows:  "Of  the  vessels  ending  in  the  heart,  some 
send  into  it  the  material  which  they  carry,  for  in- 
stance the  vena  cava  into  the  right  ventricle,  and 
the  vein-like  artery  into  the  left;  some  on  the  other 
hand  carry  material  away  from  the  heart,  as  for 
instance  the  aorta  from  the  left  ventricle  and  the 
artery-like  vein,  nourishing  the  lung,  from  the  right. 
To  each  orifice  are  attached  little  membranes  the 
function  of  which  is  to  secure  that  the  orifices  lead- 
ing in  do  not  let  out  and  that  those  leading  out  do 
not  let  in."  Caesalpinus  also  knew  that  the  arteries 
dilate  as  the  heart  contracts.  Moreover,  in  his 
"Quaestiones  Medicae"  (1593)  he  explains  why,  in 
case  of  ligature  for  venesection,  the  veins  swell  on 
the  side  of  the  ligature  away  from  the  heart,  and,  in 
general,  that  "  there  is  a  sort  of  perpetual  movement 
from  the  vena  cava  through  the  heart  and  lungs  into 
the  aorta." 

A  year  before  the  appearance  of  the  "Medical 
Questions,"  Caesalpinus  left  Pisa,  where  he  had  been 
professor  of  medicine  since  1567,  for  Rome.  At  the 
same  time  Galileo,  the  father  of  dynamics,  went 


HARVEY  AND  PHYSIOLOGY      119 

from  Pisa,  his  native  city,  to  accept  appointment  in 
the  University  of  Padua.  Though  known  mainly  as 
a  physicist,  Galileo  exerted  a  very  great  influence 
on  the  development  of  medical  science.  Born  in 
1564,  he  had  entered  the  University  of  Pisa  as  a 
student  of  medicine  in  1581,  and  almost  immediately 
discovered  that  the  time  occupied  by  the  oscillation 
of  a  pendulum  is  constant  as  measured  by  the  pulse. 
This  discovery  soon  led  to  the  invention  of  a  simple 
instrument  to  determine  the  rate  of  the  pulse 
(pulsilogium).  In  1589  Galileo  was  appointed  pro- 
fessor of  mathematics  at  the  University  of  Pisa,  and 
in  the  following  year  his  treatise  on  dynamics,  "De 
Motu  Gravium,"  was  circulated  as  a  manuscript. 
Shortly  after  his  removal  to  Padua  Galileo  invented 
the  thermoscope,  the  forerunner  of  the  clinical 
thermometer,  and  devised  a  small  but  powerful 
machine  for  raising  water.  His  lectures  attracted  to 
Padua  students  from  all  parts  of  Europe,  among 
them  the  Archduke  Ferdinand  (afterwards  Em- 
peror Ferdinand  II)  and  Cosimo  de'  Medici  (after- 
wards Cosimo  II,  Grand  Duke  of  Tuscany).  Before 
the  close  of  the  century  Galileo  had  under  his  roof 
twenty  resident  pupils,  including  a  number  of 
Englishmen.  At  the  same  time  he  was  on  familiar 
term  with  Fabricius,  the  teacher  and  friend  of 
Harvey,  and  there  is  every  reason  to  believe  that 
the  immortal  discoverer  of  the  circulation  of  the 


120     THE  HISTORY  OF  MEDICINE 

blood  in  1598-1602  came  in  contact  with  the  il- 
lustrious pupil  of  Andreas  Caesalpinus. 

William  Harvey  was  born  at  Folkestone,  on  the 
south  coast  of  England,  in  1578.  From  his  sixteenth 
till  his  twentieth  year  he  was  in  attendance  at 
Gonville  and  Caius  College,  Cambridge,  which  had 
been  refounded  by  John  Kees  (Caius),  a  former 
pupil  and  colleague  of  Vesalius  (1539-43)  at  Padua. 
During  Harvey's  undergraduate  days  Caius  College 
afforded  instruction  in  Latin,  Greek,  logic,  mathe- 
matics, and  anatomy,  and  there  is  evidence  in  his 
mature  preference  for  the  works  of  Cicero,  Aristotle, 
and  Avicenna,  in  his  interest  as  an  old  man  in  the 
"Clavis  Mathematica"  of  William  Oughtred,  and 
in  his  lifelong  devotion  to  dissection,  that  all  of 
these  early  studies  took  root  in  his  docile  and  sus- 
ceptible mind.  He  took  his  degree  in  Arts  in  1597, 
and  a  year  later  went  to  Padua  to  study  under 
Fabricius  of  Aquapendente,  who  seems  to  have 
treated  him  with  marked  cordiality.  Harvey  took  a 
prominent  part  in  the  student  organizations  which 
governed  the  University  of  Padua,  gained  the 
friendship  of  several  of  Galileo's  disciples  (Wil- 
loughby,  Fludd,  and  others),  and  graduated  with 
distinction  as  Doctor  of  Medicine  a  few  weeks  after 
the  completion  of  his  twenty-fourth  year. 

After  his  return  to  England,  Harvey  took  up 
residence  in  London,  and  was  admitted  to  the 


HARVEY  AND  PHYSIOLOGY      121 

College  of  Physicians,  founded  by  Thomas  Linacre 
—  also  a  Doctor  of  Padua  —  in  1518.  It  was  in  a 
lecture  at  this  institution  that  Harvey  gave  the  first 
exposition  (1616)  that  has  come  down  to  us  of  his 
views  concerning  the  movement  of  the  heart  and  the 
blood.  In  this  lecture  he  expressed  himself  to  the 
following  effect: 

"It  is  plain  from  the  structure  of  the  heart  that 
the  blood  is  passed  continuously  through  the  lungs 
to  the  aorta  as  by  the  two  clacks  of  a  water  bellows 
to  raise  water. 

"It  is  shown  by  the  application  of  a  ligature  that 
the  passage  of  the  blood  is  from  the  arteries  into  the 
veins. 

"Whence  it  follows  that  the  movement  of  the 
blood  is  constantly  in  a  circle,  and  is  brought  about 
by  the  beat  of  the  heart." 

Further  light  is  thrown  on  the  genesis  of  Harvey's 
views  by  the  following  passage  from  the  works  of 
the  distinguished  chemist  Robert  Boyle: 

"And  I  remember,  that  when  I  asked  our  famous 
Harvey,  in  the  only  discourse  I  had  with  him  (which 
was  but  a  while  before  he  died),  what  were  the 
things  that  induced  him  to  think  of  a  circulation  of 
the  blood?  He  answered  me,  that  when  he  took 
notice,  that  the  valves  in  the  veins  of  so  many  parts 
of  the  body  were  so  placed,  that  they  gave  free 
passage  to  the  blood  towards  the  heart,  but  op- 


122     THE  HISTORY  OF  MEDICINE 

posed  the  passage  of  the  venal  blood  the  contrary 
way;  he  was  invited  to  imagine,  that  so  provident  a 
cause  as  nature  had  not  so  placed  so  many  valves 
without  design;  and  no  design  seemed  more  prob- 
able, than  that  since  the  blood  could  not  well,  be- 
cause of  the  interposing  valves,  be  sent  by  the  veins 
to  the  limbs,  it  should  be  sent  through  the  arteries, 
and  return  through  the  veins,  whose  valves  did  not 
oppose  its  course  that  way." 

It  was  not  till  1628  that  Harvey  published  his 
"  De  Motu  Cordis  et  Sanguinis  in  Animalibus,"  after 
confirming  his  views  of  the  motion  and  function  of 
the  heart  by  the  study  of  the  structure  of  the 
auricles,  ventricles,  cardiac  valves,  the  larger  and 
smaller  arteries  and  veins,  by  experiments  in  ligatur- 
ing, by  numerous  vivisections,  by  draining  off  the 
blood  through  a  single  small  vessel,  by  calculating 
the  quantity  of  blood  passing  through  the  left 
ventricle  in  the  course  of  half  an  hour,  by  the  ob- 
servation of  pathological  conditions,  by  the  exami- 
nation of  the  vascular  system  in  human  embryos  as 
compared  with  that  of  fishes,  toads,  frogs,  serpents, 
and  lizards.  As  a  true  Aristotelian  Harvey  held  that 
it  was  as  vain  to  seek  to  base  the  science  of  anatomy 
on  an  examination  of  the  human  body  alone  as  to 
attempt  to  establish  political  science  on  the  study 
of  a  single  commonwealth. 

As  the  title  of  Harvey's  disquisition  indicates,  it 


HARVEY  AND  PHYSIOLOGY      123 

is  on  the  motion  of  the  heart  that  he  laid  the  chief 
emphasis.  In  the  introductory  letter  to  King 
Charles,  he  speaks  of  the  heart  of  animals  as  the 
foundation  of  their  life,  and  refers  to  what  he  has 
written  of  the  motions  of  the  heart.  Similarly,  in 
the  dedication  to  the  president  and  others  of  the 
Royal  College  of  Physicians,  he  makes  mention 
of  his  new  views  of  the  motion  and  function  of  the 
heart,  and  in  the  introduction  proper  Harvey 
criticizes  earlier  doctrines  as  a  preliminary  to  dis- 
cussing the  motion,  action,  and  use  of  the  heart  and 
arteries.  These  earlier  doctrines  appear  untenable 
after  we  have  closely  studied  the  structure  and 
mechanism  of  the  heart.  The  opinion  that  blood 
oozes  from  the  right  to  the  left  ventricle  through 
pores  in  the  septum  is,  according  to  Harvey,  not  to 
be  tolerated.  "For,"  he  proceeds,  "the  septum  of 
the  heart  is  of  a  denser  and  more  compact  structure 
than  any  portion  of  the  body,  except  the  bones  and 
sinews.  But  even  supposing  there  were  foramina  or 
pores  in  this  situation,  how  could  one  of  the  ventri- 
cles extract  anything  from  the  other  —  the  left,  e.g., 
obtain  blood  from  the  right  —  when  we  see  that 
both  ventricles  contract  and  dilate  simultaneously? 
Wherefore  should  we  not  rather  believe  that  the 
right  took  spirits  from  the  left,  than  that  the  left 
obtained  blood  from  the  right  ventricle,  through 
these  foramina?"  Incidentally,  if  the  septum  were 


124     THE  HISTORY  OF  MEDICINE 

permeable,  what  need  would  there  be  of  the  coro- 
nary vessels?  The  opinion  that  the  diastole  of  the 
arteries  is  simultaneous  with  that  of  the  heart  is  also 
untenable;  for  how  can  two  mutually  connected 
bodies,  simultaneously  distended,  draw  anything 
from  one  another?  Again,  in  the  opening  chapter  of 
the  "De  Motu  Cordis  et  Sanguinis,"  Harvey  states 
that  he  had  discovered  the  motions  and  uses  of  the 
heart  after  numerous  vivisections,  and  had  been  led 
to  publish  an  exposition  of  his  views.  This  he  under- 
took the  more  willingly  seeing  that  Fabricius  had 
not  written  concerning  the  structure  and  functions 
of  the  heart.  In  his  second  chapter,  which  deals 
with  the  motion  of  the  heart  as  seen  in  the  dissection 
of  living  animals,  Harvey  notes  that  the  heart  in  its 
systole  —  that  is,  in  its  essential  motion  —  becomes 
hard,  diminished  in  size,  of  a  paler  color,  and  so 
made  apt  to  project  or  expel  its  charge  of  blood. 
He  was  later  able  to  supplement  this  knowledge  of 
the  motion  of  the  heart  gained  through  vivisection 
by  direct  observation  of  the  human  heart  in  a  case 
of  extensive  injury  of  the  chest  wall.  He  then 
demonstrated  to  King  Charles,  who  was  interested 
in  his  physiological  and  embryological  investiga- 
tions, that  the  heart  in  diastole  is  retracted  and 
withdrawn  and  in  systole  emerges  and  is  protruded, 
and  also  that  the  diastole  of  the  arteries  is  simul- 
taneous with  the  systole  of  the  heart. 


HARVEY  AND  PHYSIOLOGY      125 

Proceeding  to  a  closer  scrutiny  of  the  mechanism 
of  the  heart,  Harvey  finds  that  the  heart's  motion 
begins  with  the  auricles  and  extends  to  the  ventri- 
cles, as  in  a  piece  of  machinery  one  wheel  gives 
motion  to  another,  yet  all  the  wheels  seem  to  move 
simultaneously.  The  blood  is  thrown  into  the  ven- 
tricles by  the  action  of  the  auricles.  The  motions 
of  the  heart  constitute  a  kind  of  deglutition,  a  trans- 
fusion of  the  blood  from  the  veins  to  the  arteries. 
The  valves  of  the  heart  have  the  purpose  of  pre- 
venting regurgitation.  Blood  continually  flows  into 
the  right  ventricle  and  is  continually  passed  out  of 
the  left,  and  therefore  moves  from  the  vena  cava  to 
the  aorta.  Proceeding  on  the  other  hand  from  the 
right  ventricle  into  the  lungs  by  the  pulmonary 
artery,  and  incessantly  drawn  from  the  lungs  into 
the  left  ventricle,  it  cannot  do  otherwise  than  pass 
continuously  by  the  obscure  porosities  of  the  lungs 
and  the  minute  inosculations  of  vessels.  What  is 
the  quantity  and  source  of  the  blood  that  reaches 
the  heart  by  way  of  the  vena  cava? 

Influenced  by  the  knowledge  derived  from  vivi- 
section, the  structure  of  the  ventricles  and  their 
valves,  the  relative  size  of  the  conduits  leading  to 
and  from  the  heart,  the  quantity  of  the  blood  trans- 
mitted, Harvey  "began  to  think  whether  there 
might  not  be  a  motion,  as  it  were,  in  a  circle.  Now 
this  I  afterwards  found  to  be  true ;  and  I  finally  saw 


126     THE  HISTORY  OF  MEDICINE 

that  the  blood,  forced  by  the  action  of  the  left 
ventricle  into  the  arteries,  was  distributed  to  the 
body  at  large,  and  its  several  parts,  in  the  same 
manner  as  it  is  sent  through  the  lungs,  impelled  by 
the  right  ventricle  into  the  pulmonary  artery,  and 
that  it  then  passed  through  the  veins  and  along  the 
vena  cava,  and  so  around  to  the  left  ventricle  in  the 
manner  already  indicated."  That  there  is  a  circula- 
tion of  the  blood  is  confirmed,  according  to  Harvey, 
by  the  fact  that  so  large  a  quantity  is  transmitted 
by  the  action  of  the  heart.  If  only  one  eighth  of  an 
ounce  of  blood  were  expelled  from  the  left  ventricle 
of  the  human  heart  at  each  contraction,  and  if  there 
were  two  thousand  or  even  one  thousand  pulsations 
every  hour,  a  larger  quantity  would  seem  to  be 
forced  into  the  aorta  in  half  an  hour  than  is  con- 
tained in  the  whole  body.  "  In  the  same  way,  in  the 
sheep  or  dog,  say  that  but  a  single  scruple  of  blood 
passes  with  each  stroke  of  the  heart,  in  one  half 
hour  we  should  have  one  thousand  scruples,  or  about 
three^  pounds  and  a  half  of  blood  injected  into  the 
aorta;  but  the  body  of  neither  animal  contains 
above  four  pounds  of  blood,  a  fact  which  I  have 
myself  ascertained  in  the  case  of  the  sheep." 

Harvey  recognized,  as  had  Csesalpinus,  that  the 
swelling  of  a  limb  ligatured  as  for  venesection  on 
the  side  of  the  ligature  away  from  the  heart  proves 
that  the  veins  carry  the  blood  from  the  extremities 


HARVEY  AND  PHYSIOLOGY      127 

toward  the  heart.  The  valves  which  are  found  in 
the  cavities  of  the  veins  themselves  make  plain  the 
course  of  the  circulation.  Their  function  is  simi- 
lar to  that  of  the  valves  of  the  aorta  and  the  pul- 
monary artery,  namely,  to  prevent  the  reflux  of  the 
blood.  Moreover,  the  effect  of  such  a  ligature  as  is 
used  to  bind  a  limb  for  amputation  shows  that  the 
blood  is  carried  to  the  extremities  by  the  arteries. 
The  arteries  are  conduits  leading  from  the  heart, 
while  the  veins  are  conduits  leading  to  the  heart. 
The  blood  passes  from  the  arteries  to  the  veins 
either  immediately  by  anastomoses,  or  mediately 
by  the  pores  of  the  flesh,  or  in  both  ways.  It  is 
forced  from  the  capillary  veins  into  the  smaller 
branches,  and  from  these  into  the  larger  trunks. 
It  is  necessary  to  conclude,  says  Harvey,  "that 
the  blood  in  the  animal  body  is  impelled  in  a  cir- 
cle, and  is  in  a  state  of  ceaseless  motion;  that 
this  is  the  act  or  function  which  the  heart  performs 
by  means  of  its  pulse;  and  that  it  is  the  sole  and 
only  end  of  the  motion  and  contraction  of  the 
heart." 

It  has  frequently  been  assumed  that  Harvey 
failed  to  demonstrate  the  passage  of  the  blood  from 
the  arterioles  to  the  venuoles,  and  that  the  circula- 
tion of  the  blood  was  fully  established  only  when 
Malpighi  gave  ocular  demonstration  of  the  capillary 
circulation.  Of  course  it  must  be  admitted  by  all 


that  Harvey,  in  proving  that  the  blood  is  carried 
from  the  heart  to  the  extremities  by  the  arteries  and 
is  returned  from  the  extremities  to  the  heart  by  the 
veins,  gave  logical  proof  of  a  connection  between 
the  minute  arteries  and  the  minute  veins.  But  the 
fact  that  Harvey  in  1651  demonstrated  by  means  of 
experiment  that  all  of  the  blood  from  the  right 
ventricle  passes  through  the  pulmonary  artery  to 
the  pulmonary  vein  has  been  disregarded  by  many. 
In  the  presence  of  a  number  of  his  colleagues  he  in- 
jected about  a  pound  of  hot  water  into  the  right 
ventricle  (of  the  heart  of  a  man  who  had  been 
hanged)  after  having  tied  the  pulmonary  artery. 
Not  a  drop  of  water  or  of  blood  made  its  way  into 
the  left  ventricle.  Then,  the  ligature  having  been 
undone,  water  was  injected  into  the  pulmonary 
artery,  upon  which  a  torrent  of  the  fluid,  mixed  with 
a  quantity  of  blood,  immediately  gushed  forth  from 
a  perforation  which  had  previously  been  made  in 
the  left  ventricle.  Before  making  this  experiment 
Harvey  had  reached  the  conclusion  that  spirit  and 
innate  heat  are  to  be  thought  of  only  as  properties  of 
the  blood.  "There  is,  in  fact,"  he  says,  "no  occa- 
sion for  searching  after  spirits  foreign  to  or  distinct 
from  the  blood ;  to  evoke  heat  from  another  source ; 
to  bring  gods  upon  the  scene,  and  to  encumber 
philosophy  with  any  fanciful  conceits.  What  we  are 
wont  to  derive  from  the  stars  is  in  truth  produced 


HARVEY  AND  PHYSIOLOGY      129 

at  home.  The  blood  is  the  only  calidum  innatum  or 
first  engendered  animal  heat." 

Almost  immediately  after  the  publication  of  the 
"De  Motu  Cordis,"  Harvey  was  drawn  into  the 
royal  service.  In  1629  he  was  commanded  by  King 
Charles  to  attend  James  Stuart,  Duke  of  Lennox, 
who  was  about  to  undertake  an  extensive  tour  of 
the  Continent.  In  the  following  year  he  received 
appointment  as  Physician  in  Ordinary  for  His 
Majesty's  Household,  and  became  the  personal 
friend  and  companion  of  Charles  I.  He  accom- 
panied the  monarch  on  that  journey  to  Scotland  in 
1633,  which  led  to  the  ultimate  breach  between  the 
King  and  his  Scottish  subjects.  Two  years  later,  at 
the  command  of  Charles,  Harvey  examined  the 
body  of  Thomas  Parr,  who  had  died  at  the  reputed 
age  of  one  hundred  and  fifty-two  years  and  nine 
months.  Harvey  came  to  the  conclusion  that  Parr 
might  have  lived  longer  had  he  not,  after  being 
brought  to  London  by  the  Earl  of  Arundel,  indulged 
in  rather  rich  fare,  "his  ordinary  diet  consisting  of 
subrancid  cheese,  and  milk  in  every  form,  coarse  and 
hard  bread,  and  small  drink,  generally  sour  whey." 
In  1636  Harvey  accompanied  the  Earl's  embassy  to 
Ferdinand  II  on  behalf  of  Charles's  sister  Eliza- 
beth of  the  Palatinate,  mother  of  Prince  Rupert; 
and  before  the  close  of  that  year  was  sent  to  Italy 
by  the  Earl  about  some  pictures  for  His  Majesty. 


130     THE  HISTORY  OF  MEDICINE 

Arundel  was  famous  as  an  art  collector,  and  inter- 
ested in  medical  science,  and,  we  may  add,  had  been 
seeking  to  secure  a  "booke  drawne  by  Leonardo  da 
Vinci."  On  his  way  to  Venice  Harvey  was  halted  at 
Treviso  "to  do  his  quarantine,, ,"  on  account  of  the 
plague  (August  13),  and  displayed  as  much  testiness 
as  did  the  choleric  Vesalius  when  held  up  by  ex- 
tortionate customs  officials  at  the  Spanish  frontier 
in  1564.  From  Venice  Harvey  passed  to  Florence 
(before  September  17),  where  he  was  entertained  by 
the  Grand  Duke  of  Tuscany,  Ferdinand  II,  patron 
of  the  sciences  and  son  of  Galileo's  pupil,  Cosimo  de' 
Medici.  By  December  he  had  returned  to  his  prac- 
tice in  London. 

During  the  struggle  between  Charles  I  and  his 
rebellious  subjects  Harvey  was  closely  associated 
with  the  Royalist  cause.  When  in  1639  the  King 
joined  the  army  under  the  Earl  of  Arundel  in  an 
expedition  against  the  Scottish  forces,  Harvey  ac- 
companied him.  He  was  likewise  present  when, 
three  years  later,  Charles  raised  his  standard  at 
Nottingham.  It  was  probably  about  this  time  that 
his  lodgings  at  Whitehall  were  pillaged,  and  his 
papers  and  specimens  scattered  or  destroyed.  At 
the  battle  of  Edgehill,  Harvey  had  charge  of  the  two 
young  princes  and  later  aided  in  caring  for  the 
wounded.  Harvey  was  in  attendance  on  the  King 
at  Oxford,  which  the  Royalist  forces  entered  in 


HARVEY  AND  PHYSIOLOGY      131 

triumph  October  29,  1642.  About  a  year  later  he 
treated  successfully  Prince  Maurice,  brother  of 
Rupert,  suffering  from  a  slow  fever  (typhus), 
"the  raging  disease  of  the  army."  In  1645  Harvey 
was  nominated  by  the  King  Warden  of  Merton 
College.  It  was  in  the  Warden's  House  at  Merton 
that  Henrietta  Maria,  daughter  of  Maria  de' 
Medici,  had  her  lodging  during  that  stormy  time. 
On  June  24,  1646,  Oxford  surrendered  to  the 
Parliamentary  forces;  whereupon  Harvey  seems  to 
have  retired  to  private  life. 

In  whatever  circumstances  he  might  be  placed, 
his  zeal  for  the  advance  of  medical  science  was 
always  unabated.  Traveling  with  the  Duke  of 
Lennox  through  regions  desolated  by  war,  famine, 
and  plague,  he  complained  of  the  absence  of  any- 
thing to  anatomize.  Drawn  to  Scotland  in  1633  in 
the  retinue  of  King  Charles,  he  studied  the  flights  of 
gannets  on  the  Bass  Rock.  While  accompanying 
Arundel  in  Germany  he  demonstrated  the  circula- 
tion of  the  blood  at  Nuremberg,  and,  in  spite  of  the 
unsettled  state  of  the  country,  "would  still  be  mak- 
ing observations  of  strange  trees  and  plants,  earths, 
etc.,  and  sometimes  like  to  be  lost."  The  slaughter 
of  does  in  the  royal  hunt  furnished  material  for  his 
studies  in  embryology,  and  shortly  after  arriving  at 
Oxford  he  used  to  visit  George  Bathurst  of  Trinity 
College,  "who  had  a  hen  to  hatch  eggs  in  his  cham- 


132     THE  HISTORY  OF  MEDICINE 

her,  which  they  opened  daily  to  see  the  progress  and 
way  of  generation."  His  example  had  a  great  in- 
fluence on  Highmore,  on  Scarborough,  his  favorite 
pupil,  who  "introduced  geometrical  and  mechanical 
speculations  into  anatomy,"  on  Wharton,  on  Willis, 
and  other  young  men  at  Oxford  interested  in  scien- 
tific investigation,  as  well  as  on  Glisson,  on  Ent,  and 
other  original  fellows  of  the  Royal  Society,  organized 
after  the  Restoration  for  the  promotion  of  physico- 
mathematical  experimental  learning. 

In  his  treatise,  "On  Animal  Generation,"  follow- 
ing up  the  studies  of  Aristotle  and  Fabricius  in  no 
subservient  spirit,  Harvey  declared  that  the  genera- 
tion of  the  chick  is  the  result  of  epigenesis,  and  that 
all  its  parts  are  not  fashioned  simultaneously,  but 
emerge  in  their  due  succession  and  order.  Like  his 
two  great  masters  he  also  wrote  a  treatise  on  loco- 
motion ;  he  was  a  worthy  successor  of  Aristotle  in  the 
field  of  comparative  anatomy,  and  had  a  clearer 
knowledge  than  Fabricius  of  the  physiology  of 
respiration.  He  made  use  of  his  discovery  of  the 
circulation  in  surgery,  and  was  not  unacquainted 
with  the  practice  of  obstetrics.  In  1649  he  spoke  of 
publishing  a  treatise  on  pathological  anatomy  based 
on  his  numerous  post-mortems,  and  four  years  later, 
feeling  still  vigorous  in  mind  in  spite  of  his  bodily 
afflictions  and  advanced  years,  exchanged  letters 
with  the  Florentine  Nardi  concerning  the  problem 


HARVEY  AND  PHYSIOLOGY      133 

of  contagion.  About  this  time  there  was  completed 
at  Harvey's  expense  a  building  for  the  College  of 
Physicians,  to  which  honorable  body  he  also  pre- 
sented his  patrimonial  estate  in  1656.  Toward  the 
close  of  his  life  attacks  of  the  gout,  from  which 
disease  he  had  long  suffered,  became  more  frequent. 
He  was  stricken  with  cerebral  haemorrhage  June  3, 
1657,  and  died  the  same  day. 

The  scientists  of  Harvey's  own  time  were  pre- 
pared to  accept  the  mechanical  theory  of  bodily 
functions.  As  early  as  1604,  Kepler  had  explained 
the  phenomena  of  vision  involved  in  the  refraction 
of  light  by  the  lens;  in  1614  Sanctorius  had  recorded 
his  experiments  to  determine  by  weight  the  insensi- 
ble perspiration  of  the  human  body,  and  in  1625  had 
described  a  pulsilogium  and  a  clinical  thermoscope 
of  his  own  invention;  and  in  1622  Aselli  had  ob- 
served the  lacteals  and  had  recognized  the  function 
of  the  valves  discovered  in  them.  After  the  publica- 
tion of  Harvey's  "De  Motu  Cordis  et  Sanguinis" 
the  French  philosopher  Descartes,  accepting  in  the 
main  the  doctrine  of  the  circulation  of  the  blood, 
proceeded  to  sketch  his  views  of  the  human  ma- 
chine (1634),  man  tne  automaton,  which  were  later 
developed  in  his  treatise  "De  Homine."  Jan  de 
Wale  confirmed  (1640),  by  making  incisions  in 
ligatured  vessels,  Harvey's  teaching  concerning  the 
direction  of  the  flow  of  the  blood  in  veins  and  ar- 


134     THE  HISTORY  OF  MEDICINE 

teries;  Georg  Wirsung  discovered  (1642)  the  pan- 
creatic duct;  Pecquet  made  known  (1651)  his  dis- 
covery that  the  lacteals  pour  their  contents  into  the 
receptaculum  chyli,  and  that  the  thoracic  duct 
(previously  observed  by  Eustachius)  leads  thence 
to  the  left  subclavian  vein;  the  lymphatic  vessels 
were  noted  by  the  Cambridge  student  George  Joy- 
liffe  in  1652,  and,  about  the  same  time,  Rudbeck 
traced  the  connection  of  the  lymphatics  of  the  liver 
and  intestines  with  the  receptaculum  chyli  and 
thoracic  duct.  Before  the  death  of  Harvey,  Whar- 
ton  discovered  the  duct  that  bears  his  name,  and 
Glisson  gave  an  accurate  description  of  the  capsule 
of  the  liver. 

Willis  was  aided  in  the  preparation  of  his  "  Cerebri 
Anatome"  (1664)  by  Sir  Christopher  Wren  and  by 
Richard  Lower,  who  in  his  "Tractatus  De  Corde" 
furthered  the  work  of  Harvey  by  definitely  applying 
the  new  science  of  physics  to  explain  the  mechanism 
of  the  heart.  Robert  Hooke  (the  first  microscopist 
to  observe  the  cellular  structure  of  plants)  by  ex- 
periments in  artificial  respiration  (1667)  proved  that 
life  may  be  maintained  without  muscular  movement 
so  long  as  the  lungs  are  supplied  with  fresh  air;  and 
John  Mayow  in  the  following  year  demonstrated 
that  in  respiration  only  part  of  the  air  is  taken  up 
by  the  lungs,  and  that  the  gas  which  supports  life  is 
identical  with  that  which  supports  combustion. 


HARVEY  AND  PHYSIOLOGY      135 

In  the  meantime  the  influence  of  Galileo  and 
Harvey  had  advanced  the  cause  of  physiological 
research  in  Italy.  Much  of  the  progress  centers 
about  the  name  of  Ferdinand  II  of  Tuscany,  whose 
brother  Leopold  de'  Medici  improved  the  thermo- 
scope  of  Galileo  and  was  the  first  president  of  the 
Accademia  del  Cimento,  founded  at  Florence  in 
1657.  To  the  University  of  Pisa,  Ferdinand  called 
Borelli,  Malpighi,  Bellini,  and  Stensen.  For  Borelli, 
the  disciple  of  Galileo,  physiology  was  a  part  of 
physics.  He  recognized  that  the  action  of  a  muscle 
is  a  mere  contraction  of  its  length,  due  to  the  fibers, 
or  muscle  substance  proper,  and  not  to  the  tendon. 
He  estimated  in  pounds  the  force  of  the  muscles 
of  the  jaw  and  heart.  The  motion  of  the  heart 
differs  from  that  of  the  arm  or  leg  in  being  non- 
volitional;  it  may  be  automatic,  or  caused  by  some 
organic  necessity.  The  heart  is  like  a  wine-press, 
and,  by  propelling  the  blood  into  the  arteries, 
causes  them  to  distend.  The  arteries,  then  con- 
tracting, force  the  blood  into  their  ramifications. 
By  means  of  the  microscope  Malpighi,  distinguished 
in  embryology,  pathology,  and  histology,  observed 
(1661)  the  capillaries  in  the  lung,  mesentery,  etc., 
of  the  frog,  as  well  as  in  the  lung  of  the  tortoise. 
He  thus  found  that  the  blood  is  always  contained 
in  vessels,  and  does  not  escape  from  the  arterioles 
to  be  taken  up  by  the  venuoles.  These  observations 


136     THE  HISTORY  OF  MEDICINE 

were  confirmed  by  Leeuwenhoek  (1668),  by  the 
Irish  scientist  William  Molyneux  (1683),  and  others. 
In  1665  Malpighi  observed  the  red  blood  corpuscles, 
but  in  this  discovery  he  had  been  anticipated  by 
Swammerdam.  Bellini's  study  of  the  minute  struc- 
ture of  the  kidneys  and  Malpighi's  histological 
examination  of  the  spleen,  liver,  brain  cortex,  lungs, 
tongue,  skin,  etc.,  as  well  as  of  the  kidneys,  became 
the  basis  of  a  more  definite  knowledge  of  the 
physiological  action  of  these  parts.  The  correlation 
of  structure  and  function  was  the  dominant  idea  of 
these  investigators.  Stenson,  the  discoverer  of  the 
duct  of  the  parotid  gland,  furthered  the  investiga- 
tions of  Borelli  in  reference  to  the  mechanism  of  the 
muscles. 

It  seems  almost  like  a  travesty  of  the  mechanical 
theory  of  physiological  action  that  in  a  later  genera- 
tion it  was  taught,  not  only  that  the  heart  and 
vessels  resemble  waterworks  and  that  the  chest  is 
like  bellows,  but  that  the  glands  may  be  compared 
to  sieves,  the  teeth  to  scissors,  and  the  stomach  to  a 
flask. 

REFERENCES 

Brooks,  W.  K.:  William  Harvey  as  an  Enibryologist,  Johns 
Hopkins  Hospital  Bulletin,  1897,  vin,  pp.  167-74. 

Curtis,  John  G.:  Harvey's  Views  on  the  Use  and  Circulation  of 
the  Blood.  Columbia  University  Press,  1915.  194  pp. 

Foster,  Sir  Michael:  Lectures  on  the  History  of  Physiology. 
Cambridge  University  Press,  1901.  310  pp. 


HARVEY  AND  PHYSIOLOGY      137 

Haldane,  Elizabeth  S.:  Descartes,  his  Life  and  Times.   London, 

1905-  398  PP- 

Mitchell,  Weir  S. :  The  Early  History  of  Instrumental  Precision 
in  Medicine,  2d  Congress  of  Am.  Physicians  and  Surgeons, 
1891,  pp.  159-81. 

Some  Recently  Discovered  Letters  of  William  Han>ey.  Phila- 
delphia, 1912.   59  pp. 

Tierney,  M.  A.:  The  History  and  Antiquities  of  the  Castle  and 
Town  of  Arundel.  London,  1834,  2  vols.  772  pp.  (pagina- 
tion continuous). 

Moore,  Norman:  "William  Harvey,"  The  Dictionary  of  National 
Biography. 

Power,  D'Arcy:  William  Harvey.  London,  1897.  283  pp. 
(Bibliographical  appendix.) 

Willis,  Robert:  The  Works  of  William  Harvey.  Translated  from 
the  Latin  with  a  Life  of  the  Author.  London,  The  Syden- 
ham  Society,  1847.  624  pp. 


CHAPTER  VII 

SCIENCE  AND  PRACTICE:  SYDENHAM, 
BOERHAAVE 

Is  it  possible  to  be  a  great  physician  without  an  in- 
timate knowledge  of  up-to-date  science?  Should  the 
focus  of  a  doctor's  attention  be  something  else  than 
anatomy,  histology,  physiology,  embryology,  bac- 
teriology, chemistry,  etc.?  The  lives  of  Thomas 
Sydenham  and  Hermann  Boerhaave  give  us  occa- 
sion to  consider  these  questions. 

Sydenham's  early  life  served  to  develop  his  prac- 
tical, rather  than  his  theoretical,  tendencies.  Born 
of  a  family  of  Puritan  gentry  at  Wynford  Eagle, 
Dorsetshire,  September,  1624,  he  went  in  1642  to 
Oxford,  where  his  eldest  brother  William  —  soon  to 
gain  distinction  as  one  of  Cromwell's  officers  and 
councillors  —  was  already  in  residence.  Thomas 
was  enrolled  in  May  at  Magdalen  Hall,  the  recog- 
nized center  of  Oxford  Puritanism,  but  he  was  com- 
pelled within  a  few  months,  or  weeks,  to  quit  the 
University  on  account  of  the  impending  struggle 
between  the  King  and  the  Parliament.  He  returned 
to  his  home  in  Dorset,  where  the  Sydenham  family 
became,  in  the  bitter  local  warfare  that  followed, 
the  leaders  of  the  Parliamentary  forces.  The  father 


SCIENCE  AND  PRACTICE        139 

fought  with  the  rank  of  Captain ;  William  Sydenham 
became  Colonel  and  Governor  of  Weymouth;  the 
mother,  daughter  of  Sir  John  Jeffrey,  was  killed  by  a 
Royalist  officer  in  1644,  and  was  avenged  by  one  of 
the  elder  sons;  Francis,  a  gallant  young  Major,  fell 
a  few  months  later  in  the  defense  of  Weymouth; 
and  Thomas,  shortly  after,  was  wounded  in  a 
cavalry  skirmish. 

The  fortunes  of  war  which  caused  the  departure 
of  Sydenham  from  Oxford  also  brought  about,  as 
we  have  seen  in  the  last  chapter,  the  arrival  of  the 
Royalist  Harvey;  and,  when  peace  was  restored  in 
1646  and  the  University  passed  to  the  control  of  the 
Parliamentarians,  Harvey  retired  from  his  post  at 
Merton  and  the  Puritan  soldier  returned  to  his 
studies.  Influenced  by  the  advice  of  William's 
physician,  Thomas  Coxe,  a  Doctor  of  Padua,  and 
later  a  Fellow  of  the  Royal  Society,  Thomas  Syden- 
ham now  devoted  himself  to  the  profession  of  medi- 
cine. No  doubt  he  availed  himself  of  the  opportuni- 
ties afforded  at  Oxford  for  the  study  of  anatomy 
and  botany  and  the  reading  of  Hippocrates  and 
other  medical  classics,  but,  though  he  left  Magdalen 
Hall  for  Wadham  College,  soon  to  become,  under 
the  Wardenship  of  John  Wilkins,  the  center  of 
scientific  research  and  the  cradle  of  the  Royal 
Society,  there  is  no  evidence  that  he  was  at  all  at- 
tracted to  the  pursuit  of  truth  merely  for  the  truth's 


140     THE  HISTORY  OF  MEDICINE 

sake.  This  is  all  the  more  striking  in  view  of  the  line 
of  brilliant  devotees  of  medical  science  who  were  at 
Oxford  during  the  years  of  Sydenham's  prolonged 
residence  —  Willis,  Wharton,  Highmore,  Petty, 
Goddard,  Lower,  Wren,  Locke,  Boyle,  and  others. 
He  was  created  Bachelor  of  Medicine  in  1648,  and 
probably  received  also  the  degree  of  Master  of  Arts, 
some  allowance  4>eing  made,  no  doubt,  for  the  fact 
that  his  studies  had  been  interrupted  by  four  years 
of  civil  war. 

In  October,  1648,  Sydenham  was  made  a  Fellow 
of  All  Souls'  College,  an  appointment  he  continued 
to  hold  for  about  seven  years.  In  the  spring  of 
1651,  however,  he  was  commissioned  Captain  of 
cavalry,  and  during  the  subsequent  months  he 
served  in  the  second  Civil  War,  in  which  one  of  his 
younger  brothers,  Major  John  Sydenham,  was 
killed  in  Scotland,  and  in  which  Thomas  himself  had 
many  stirring  adventures,  and  seems  on  one  occa- 
sion to  have  been  left  on  the  field  among  the  dead. 
In  September  of  the  same  year,  all  serious  fighting 
having  ended  with  Cromwell's  victory  over  Charles 
II  at  Worcester,  Sydenham  was  free  to  return  to  his 
studies.  Before  the  close  of  1653  Christopher  Wren 
was  appointed  a  Fellow  of  All  Souls',  but  none  of 
the  associations  of  college  life  could  convince  the 
"trooper  turned  physician"  that  the  discovery  of 
some  minute  part  in  the  human  body,  or  the  search 


SCIENCE  AND  PRACTICE         141 

for  final  causes  and  the  essential  nature  of  disease, 
was  the  only  way  in  which  a  doctor  might  promote 
the  glory  of  God  and  the  welfare  of  the  human  race. 
It  was  thus  that  he  thought  of  his  vocation.  In 
1655  he  relinquished  his  fellowship,  married,  and 
established  himself  in  practice  in  London. 

Although  Sydenham  was  not  ambitious  of  the 
name  of  philosopher,  and,  as  a  follower  of  Francis 
Bacon,  sought  to  avoid  premature  hypotheses  and 
mere  speculation,  yet  scattered  through  his  writings 
are  passages  which  outline  a  sort  of  philosophy  not 
unknown  in  the  American  schools  of  to-day.  In  the 
case  of  Sydenham  it  was  the  outcome  of  his  strongly 
marked  individuality,  his  concentration  of  purpose, 
his  Puritan  training,  his  career  as  a  soldier  and 
successful  practitioner.  In  his  view  practice  is  the 
touchstone  of  theory;  the  proof  of  the  pudding  is  in 
the  eating.  He  thought  so  little  of  opinions  of  any 
sort  that  he  distrusted  his  own  when  they  came  in 
conflict  with  any  one  else's.  And  he  would  distrust 
them  even  as  regards  his  best  established  methods 
of  treatment,  were  it  not  that  the  phenomena  of 
practice  support  the  judgment  of  reason.  We  are 
forced  to  recognize  the  limitations  of  the  human 
mind.  There  may  be  beings  in  those  brighter  orbs, 
which  are  scattered  over  the  infinite  expanse  of  the 
universe,  whose  intelligences  far  exceed  those  of 
finite  man.  "Man,  indeed,"  he  proceeds,  "may  so 


142     THE  HISTORY  OF  MEDICINE 

have  his  intellectual  faculties  shaped  by  Nature 
[that  is,  the  whole  complication  of  natural  causes] 
as  to  be  enabled  to  perceive  not  what  is  absolute 
truth,  but  only  that  which  is  necessary  for  him  to 
know,  and  fitted  to  his  nature.  This  applies  to  those 
whose  medicine  consists  in  vain  speculations  rather 
than  in  that  solid  experience  which  rests  upon  the 
basis  of  the  senses." 

Through  his  interest  in  religion,  Sydenham  was 
even  drawn  into  the  field  of  metaphysics,  as  is  to  be 
seen  in  the  splendid  fragment  on  "Rational  The- 
ology." In  this,  with  the  aim  of  encouraging  right 
conduct,  the  author  develops  arguments  in  favor  of 
the  existence  of  God,  the  supremacy  of  the  imma- 
terial over  the  material,  and  the  immortality  of  the 
soul,  but  breaks  off  when  it  dawns  on  his  candid 
mind  that  a  belief  in  everlasting  rapture  and  tor- 
ment is  not  essential  to  the  practice  of  virtue. 

Sydenham's  predominant  interest  in  the  imme- 
diately practical  inclined  him  to  turn  from  problems 
in  medical  science  for  which  he  saw  no  prospect  of 
an  early  solution.  "Etiology,"  he  writes,  "is  a 
difficult,  and,  perhaps,  an  inexplicable  affair;  and 
I  choose  to  keep  my  hands  clear  of  it."  The  in- 
trinsic or  essential  nature  of  the  plague  and  of 
venereal  disease  is  unknown;  and  as  "to  what  may 
be  the  essence  of  smallpox,  I  am,  for  my  own  part, 
free  to  confess  that  I  am  wholly  ignorant;  this  in- 


SCIENCE  AND  PRACTICE        143 

tellectual  deficiency  being  the  misfortune  of  human 
nature,  and  common  to  myself  and  the  world  at 
large."  It  is  in  Sydenham's  opinion  impossible  for 
the  physician  to  discover  the  ultimate  causes  of  the 
majority  of  diseases,  which  are  inscrutable,  and  it  is 
quite  sufficient  to  know  whence  the  mischief  imme- 
diately arises.  In  fact,  the  "whole  philosophy  of 
medicine  consists  in  working  out  the  histories  of 
diseases,  and  applying  the  remedies  which  may  dis- 
pel them;  and  Experience  is  the  sole  guide." 

During  the  first  few  years  of  his  practice  in  Lon- 
don, Sydenham  had  been  fully  occupied  observing 
the  general  symptoms  of  fever.  At  that  time  inter- 
mittent fever  and  influenza  were  epidemic  in  Eng- 
land. Not  far  from  Sydenham's  residence  in  King 
Street,  Whitehall,  there  lay  a  stretch  of  low  and 
swampy  land,  and  it  is  interesting  to  note  that 
he  early  mentioned  that  abundant  swarms  of  in- 
sects in  summer  are  the  precursors  of  autumnal 
diseases,  and  that  before  the  end  of  his  career  he 
believed  that  a  causal  relationship  existed  between 
a  marshy  atmosphere  and  quartan  ague.  In  Sep- 
tember, 1658,  Oliver  Cromwell  died  at  Whitehall  of 
an  obscure  fever,  which  his  physicians  called 
"bastard  tertian."  In  the  following  year  it  is  prob- 
able that  Sydenham  visited  Montpellier,  and  his 
absence  from  London  at  the  critical  period  following 
the  Protector's  death  may  have  been  suggested  by 


144     THE  HISTORY  OF  MEDICINE 

the  dangers  to  which  his  political  leanings  exposed 
him;  for  at  the  beginning  of  1659  he  had  sought 
election  to  Parliament  as  representative  for  Wey- 
mouth,  and  having  failed  in  his  candidature,  re- 
ceived a  government  appointment.  We  do  not  hear 
of  him  again  in  London  till  the  summer  of  1660, 
after  the  Restoration.  Then  he  was  suffering  from 
an  attack  of  gout,  to  which  disease,  like  Harvey,  he 
was  a  martyr. 

After  the  summer  of  1661  Sydenham  was  able  to 
pay  attention  to  the  more  general  aspects  of  the 
diseases  he  met  in  his  practice.  To  be  appreciated 
his  writings  should  be  studied  in  connection  with 
the  mortality  statistics  of  London,  then  a  city  of 
about  400,000  inhabitants,  and  the  history  of 
epidemics.  His  first  treatise,  "Thomas  Sydenham's 
Method  of  Treating  Fevers,  based  on  his  own  Ob- 
servation "  (1666),  deals  with  the  epidemics  of 
1661-1664.  It  was  dedicated  to  Robert  Boyle,  who 
in  1660  had  published  the  results  of  his  experiments 
on  air,  who  was  interested  in  the  effects  of  Peruvian 
bark  and  the  discovery  of  other  specifics,  who  had 
occasionally  accompanied  Sydenham  in  visiting  the 
sick,  and  who  had  suggested  the  composition  of  the 
"Methodus  Curandi  Febres."  Of  the  16,665  deaths 
occurring  in  London  in  the  year  1661  the  mortality 
statistics  assign  fevers  as  the  cause  of  3490.  Under 
this  class  of  disease  were  included,  besides  inter- 


SCIENCE  AND  PRACTICE        145 

mittents,  "spotted  fever"  (typhus),  and,  probably, 
infantile  remittent  fever  and  other  ailments  marked 
by  high  temperatures.  After  some  abatement  of 
fevers  in  1662-64,  there  was  an  increase  to  5257 
deaths  in  1665,  but  the  prevailing  epidemic  of  that 
year  was  of  course  the  plague,  which  claimed  no 
fewer  than  68,596  victims.  This  Great  Plague  of 
London  was  associated  by  the  Puritans  with  the 
evils  of  monarchy.  In  the  first  year  of  the  reign  of 
James  I  an  epidemic  of  plague  had  caused  33,000 
deaths  in  London,  and  in  the  first  year  of  the  reign 
of  Charles  I,  41,000.  Sydenham  speaks  of  it  as  "the 
scourge  for  the  enormity  of  our  sins,"  and  considers 
it  as  not  amenable  to  ordinary  treatment.  He  with- 
drew from  the  city  when  the  epidemic  was  approach- 
ing its  culmination,  but  returned  later,  and  recorded 
his  observations  in  the  second  edition  of  the  "  Meth- 
odus."  The  appearance  of  this  second  book  was  the 
occasion  of  a  letter  to  Boyle,  the  father  of  modern 
chemistry,  1668  (erroneously  ascribed  by  the  "En- 
cyclopaedia Britannica,"  Latham,  Payne,  and  other 
biographers  of  Sydenham,  to  the  year  1688),  which 
shows  his  pride  in  his  practice,  and  contains  a  little 
playful  irony  regarding  his  knowledge  of  science. 
"I  have  the  happiness  of  curing  my  patients,"  he 
writes;  "at  least  of  having  it  said  of  me,  that  few 
miscarry  under  me;  but  cannot  brag  of  my  corre- 
spondency with  some  other  of  the  faculty,  who,  not- 


146     THE  HISTORY  OF  MEDICINE 

withstanding  my  profoundness  in  palmistry  and 
chemistry,  impeach  me  with  great  insufficiency,  as  I 
shall  likewise  do  my  taylor,  when  he  makes  my 
doublet  like  a  hopsack,  and  not  before,  let  him  ad- 
here to  what  hypothesis  he  will." 

From  this  letter  we  learn  also  that  the  physician 
and  philosopher,  John  Locke,  had  been  attending 
with  Sydenham  very  many  of  his  variolous  patients. 
In  the  year  1666  the  total  number  of  deaths  in  Lon- 
don had  fallen  to  12,738.  These  included  1998 
deaths  from  plague,  and  only  741  from  fevers,  38 
from  smallpox,  and  3  from  measles.  In  1667  the 
mortality  from  plague  had  dropped  to  35,  from 
fevers  had  risen  to  916,  and  from  smallpox  and 
measles  respectively  to  1196  and  82.  In  1668  there 
were  14  deaths  from  plague,  1247  from  fevers,  1987 
from  smallpox,  and  200  from  measles.  In  1669 
dysentery  and  other  intestinal  diseases,  which  had 
been  on  the  increase  since  1666,  caused  4,385  deaths, 
plague  3,  fevers  1499,  smallpox  951,  and  measles  15. 
The  dysenteric  constitution,  which  Sydenham  com- 
pares with  the  epidemics  of  North  Africa  (Morocco), 
was  maintained  during  the  next  three  or  four  years. 
Before  1673  smallpox  was  again  on  the  increase;  it 
continued  to  gain,  and  in  1674  became  the  predomi- 
nant epidemic.  Out  of  17,244  deaths  in  London  in 
the  year  1674  there  were  2507  from  smallpox,  795 
from  measles,  3  from  plague,  2,164  from  fevers,  and 


SCIENCE  AND  PRACTICE        147 

1777  from  dysentery  and  other  intestinal  ailments. 
In  1675,  as  we  learn  from  Sydenham,  there  pre- 
vailed in  London  epidemic  coughs  with  pleurisy  and 
pneumonia.  "Sometimes,"  he  states,  "there  super- 
vene upon  the  cough  the  following  symptoms:  a 
succession  of  chills  and  flushes;  pains  in  head,  back, 
and  limbs;  an  occasional  tendency  to  sweats  (espe- 
cially night  sweats) ;  sometimes  the  addition  of  pain 
in  the  side;  sometimes  a  constriction  and  tightness 
at  the  chest;  and,  as  the  result  of  this  last,  difficulty 
of  breathing,  tightness  in  the  cough,  and  violent 
fever."  In  a  work  with  the  significant  title  "  Medical 
Observations  Concerning  the  History  and  Cure  of 
Acute  Diseases"  (1676),  which  may  be  considered  a 
third,  much  enlarged,  edition  of  the  "Methodus," 
Sydenham  placed  before  the  learned  world  an  ac- 
count of  the  history  and  treatment  of  the  epidemics 
of  fifteen  years. 

The  "  Observations  Medicae"  is  much  more  than 
a  contribution  to  epidemiology.  It  aims  to  give 
graphic  and  natural  descriptions  of  disease  based  on 
well-considered  clinical  data,  and  to  establish  a 
definite  therapeutic  procedure.  He  proposes  as  a 
follower  of  Bacon  to  advance  from  the  observation 
of  individual  cases,  and  to  reduce  all  diseases  to 
clearly  defined  "species,  and  that,  with  the  same 
care  which  we  see  exhibited  by  botanists  [like  his 
contemporaries  Grew  and  Ray]  in  their  phytolo- 


148     THE  HISTORY  OF  MEDICINE 

gies."  To  write  the  natural  history  of  a  disease  the 
physician  should  hold  in  abeyance  every  philo- 
sophical hypothesis  and  prepossession,  and  imitate 
"the  exquisite  industry  of  those  painters  who  repre- 
sent in  their  portraits  the  smallest  moles  and  the 
faintest  spots."  At  the  same  time  it  is  necessary  to 
portray  in  the  clinical  picture  what  is  typical  and 
characteristic  of  the  species  rather  than  the  ad- 
ventitious or  merely  individual  phenomena.  "No 
botanist,"  says  Sydenham,  "takes  the  bites  of  a 
caterpillar  as  a  characteristic  of  a  leaf  of  sage." 
Moreover,  diseases  must  be  studied  in  relation  to 
the  time  of  year  in  which  they  occur,  for  though 
many  are  good  throughout  the  twelvemonth,  others 
follow  the  seasons  as  truly  as  plants  and  birds  of 
passage. 

The  main  part  of  medicine  is  the  discovery  of  the 
indications  of  the  various  species  of  disease.  These 
indications  or  symptoms  furnish  a  clue  to  the  right 
treatment,  for  disease  is  nothing  but  Nature's  effort 
to  restore  the  health  of  the  patient  by  the  elimina- 
tion of  the  morbific  matter  or  to  effect  a  renovation 
of  the  blood.  For  example,  gout  seeks  to  purify  the 
blood  of  old  men,  plague  to  expel  those  infectious 
particles  which  we  have  taken  in  along  with  the  air 
we  breathe,  just  as  an  abscess  may  help  to  remove  a 
thorn.  Our  natures  are  the  physicians  of  our  dis- 
eases, as  indeed  Hippocrates,  that  divine  old  man, 


SCIENCE  AND  PRACTICE        149' 

taught.  In  the  case  of  some  diseases  the  practitioner 
should  maintain  the  expectant  attitude,  or  remain 
merely  passive.  He  should,  however,  not  hesitate  to 
reenforce  the  efforts  of  Nature  when  she  is  enfeebled 
and  to  coerce  her  when  outrageous,  always  duly  at- 
tending to  her  method  and  time  of  working  a  cure. 
To  develop  a  system  of  natural  therapeutics,  a  fixed 
and  consummate  method  of  treating  disease,  veri- 
fied by  a  sufficient  number  of  experiments,  must  be 
the  result  of  cooperation.  "If,  in  each  age  of  the 
world,"  writes  Sydenham,  "a  single  person  only  had 
properly  treated  upon  one  single  disease,  the  pro- 
vince of  the  physician,  or  the  art  of  healing,  would 
long  ago  have  reached  its  height;  and  would  have 
been  as  complete  and  perfect  as  the  lot  of  humanity 
admits."  Sydenham  recognized  that  medicine  was 
to  be  advanced  not  merely  by  the  preparation  of 
accurate  descriptions  of  diseases  and  the  establish- 
ment of  a  definite  method  of  treating  them,  but  also 
by  the  discovery  of  specific  remedies,  an  interest  in 
which  he  shared  with  Robert  Boyle. 

In  describing  the  symptoms  of  the  fevers  of  1661- 
64,  Sydenham  states  that  all  agues  begin  with  shiv- 
erings  and  rigors,  succeeded  by  heat,  and  termi- 
nated by  sweats.  In  the  hot  and  cold  paroxysms  the 
patient  has  a  strong  desire  to  vomit.  One  may  speak 
of  the  stage  of  exhorrescence,  the  stage  of  ebullition, 
and  the  stage  of  despumation.  The  commotion  of 


150     THE  HISTORY  OF  MEDICINE 

the  blood  is  Nature's  means  of  bringing  about  a 
purification  or  renovation.  For  illustration  it  may 
be  compared  with  ebullition  or  fermentation.  Vernal 
intermittents  are  analogous  to  the  workings  of  full 
beer  barrels,  when,  having  lain  long  in  cool  cellars, 
they  are  set  near  a  fire.  Depuration  occurs  by  flow- 
ers or  by  dregs.  The  physician  should  be  guided  by 
Nature  in  the  exhibition  of  emetics,  diaphoretics,  or 
purgatives.  Evacuation  by  means  of  clysters  may 
act  as  an  oversized  vent  for  beer  whilst  it  is  ferment- 
ing. If  the  patient  was  advanced  in  years  or  had 
been  pulled  down  by  evacuations,  Sydenham  pre- 
scribed cordials.  " But,"  he  writes,  "if  the  fermenta- 
tion be  neither  too  active  nor  too  languid,  I  leave  it 
to  itself,  and  use  no  remedies."  Sydenham,  the  Eng- 
lish Hippocrates,  had  faith  in  the  vis  medicatrix 
natures,  and  resembled  the  Father  of  Medicine  in  his 
doctrine  of  atmospheric  constitutions,  in  his  avoid- 
ance of  extremes,  in  his  distrust  of  speculation  and 
in  the  inclination  to  ground  philosophy  on  observa- 
tion and  practice,  in  his  lofty  professional  ideals, 
respect  for  patients,  and  universal  charity,  in  his 
humoral  physiology,  in  his  diagnosis  and  prognosis, 
in  the  use  of  cooling  drinks,  in  his  resort  to  hygienic 
measures  (diet,  riding  and  carriage  exercise)  and  in 
his  employment  of  simple  remedies.  At  the  same 
time  Sydenham's  name  is  associated  with  advances 
in  the  use  of  drugs,  with  the  popularization  of  Peru- 


SCIENCE  AND  PRACTICE        151 

. 

vian  bark  in  the  treatment  of  intermittent  fever,  with 

its  recognition  as  a  tonic,  with  the  introduction  of 
liquid  laudanum  and  other  preparations  of  opium, 
and  with  the  exhibition  of  steel  and  mercury.  He 
found  antimonial  emetics  are  not  fit  for  children 
under  fourteen  years  of  age.  "I  wish,  with  all  my 
heart,"  he  writes,  "that  instead  of  them  something 
more  safe,  and  equally  efficacious,  could  be  dis- 
covered." For  kidney  troubles  he  recommended  the 
waters  of  different  mineral  springs,  among  them  the 
waters  of  the  suburb  of  London  now  known  by  his 
name. 

Among  his  contemporaries  Sydenham  was  partic- 
ularly noted  for  his  so-called  cooling  method  of 
treating  smallpox.  He  certainly  held  that  the  danger 
from  cold  in  this  disease  is  far  less  than  that  from  a 
too  heating  regimen.  He  burlesqued  the  treatment 
then  in  vogue,  and  asked  whether  the  subject's  life 
might  not  be  in  danger  if  the  stoutest  porter  in  the 
best  of  health  were,  for  the  sake  of  experiment,  put 
to  bed  with  the  curtains  drawn  and  a  large  fire  in  the 
room  to  keep  him  in  a  sweat  for  some  weeks,  there 
being  in  attendance  a  nurse  or  two,  who,  if  he  should 
shift  his  position  or  put  a  finger  out  of  bed,  should 
correct  his  error  by  heaping  on  more  clothes,  and 
who,  during  all  this  time,  should  deny  him  small 
beer  or  other  refreshing  drinks  and  continue  to  ply 
him  with  posset  and  cordials.  "From  an  overhot 


152     THE  HISTORY  OF  MEDICINE 

regimen,"  he  writes,  "never  good  came,  any  more 
than  from  overhasty  fruit  any  profit."  The  separa- 
tion of  the  peccant  matter  from  the  humors  must  be 
effected  before  it  is  eliminated  by  the  skin.  We  must, 
however,  "not  be  so  intent  upon  ensuring  against 
an  overheated  state  of  the  blood,  as  to  expose  our 
patient  to  any  injury  from  cold,  and  by  so  doing 
arrest  the  eruption  of  the  pustules."  Sydenham, 
though  he  clearly  distinguished  the  two  diseases, 
treated  measles  in  much  the  same  way  as  smallpox, 
and  taught  that  the  former  is  a  disease  superinduced 
upon  the  blood  during  an  attempt  at  a  new  stasis, 
and  that  one  attack  assures  as  a  rule  against 
another.  There  is  much,  in  fact,  in  Sydenham's 
views  of  smallpox  and  measles  that  is  reminiscent 
of  Rhazes,  as  there  is  also  in  his  view  that  disease 
may  be  explained  as  a  fermentation  of  the  humors. 
It  is  probable,  however,  that  the  latter  conception 
at  least  was  suggested  to  Sydenham  by  the  writ- 
ings of  Willis  or  of  some  other  physician  of  his  own 
time. 

Indeed,  although  Sydenham  focused  his  attention 
on  the  symptoms  and  treatment,  there  is  sufficient 
evidence  that  he  did  not  avoid  adopting  hypotheses 
regarding  the  nature  and  causation  of  disease.  In 
harmony  with  Locke  and  Boyle  he  believed  that 
the  human  frame  is  adapted  to  impressions  from 
without,  and  that  maladies  are  owing  in  part  to 


SCIENCE  AND  PRACTICE         153 

mineral  effluvia  or  other  occult  atmospheric  influ- 
ences —  to  particles  of  the  atmosphere  —  and  in 
part  to  the  different  fermentations  and  putrefactions 
of  the  humors.  He  even  compares  diseases  with  the 
mosses,  fungi,  and  mistletoe  that  grow  on  trees,  the 
nutritive  juice  of  which  may  have  suffered  perver- 
sion or  depravation.  At  the  same  time  he  was  aware 
that  not  merely  the  delicate  are  subject  to  infection. 
A  man  might  be  as  strong  as  a  wrestler,  but  if  he 
went  to  certain  parts  of  the  country  where  fever 
was  raging,  he  would  sicken  within  a  day  or  two. 
When  in  cases  of  intermittent  fever  the  despuma- 
tion  has  been  incomplete,  the  fit  may  return  when 
the  patient  seems  out  of  danger;  the  latent  matter 
presents  itself  anew,  like  "broods  of  bees  that 
grow  gradually  at  stated  times."  The  conditions 
that  produce  plague  were  for  Sydenham  a  special 
object  of  curiosity,  and  the  study  of  them  brought 
him  near  to  a  juster  view  than  Boyle's  theories 
afforded  of  the  part  played  by  the  atmosphere  in 
the  dissemination  of  disease.  He  had  grave  suspi- 
cions that  the  mere  atmospheric  constitution  was 
insufficient  to  originate  plague.  The  disease  must 
be  perpetuated  in  sporadic  cases  in  the  intervals  be- 
tween epidemics,  or  must  continue  to  survive  in 
some  fomes,  or  arise  from  some  infected  person  from 
a  pestilential  locality.  Otherwise  Sydenham  could 
not  account  for  the  fact  that  through  the  sanitary 


154    THE  HISTORY  OF  MEDICINE 

measures  of  the  Grand  Duke  Ferdinand  II  there 
had  been  stopped  in  1650  at  the  borders  of  Tuscany 
a  plague  that  had  devastated  nearly  all  the  rest 
of  Italy.  When  an  epidemic  rages,  the  exhalations 
from  the  sick  and  from  the  corpses  of  the  victims 
of  the  disease  spread  the  contagion  through  the 
whole  atmosphere  of  the  affected  area,  so  that  the 
air,  in  itself  and  of  itself,  is  sufficient  to  destroy 
those  whose  humors  are  adapted  to  the  receipt  of 
the  influence.  As  regards  the  treatment  of  the 
plague,  Sydenham  remarks  that  Nature's  method 
of  eliminating  the  morbific  matter  by  means  of  ab- 
scesses cannot  be  furthered  by  means  of  diaphoresis, 
and  that  it  is  here  unsafe  for  the  physician  to  at- 
tempt to  follow  the  path  of  Nature. 

In  1680  appeared  Sydenham's  fourth  book, 
"Epistolse  responsoriae  duae,"  addressed  to  two  phy- 
sicians connected  with  the  University  of  Cambridge, 
from  which  institution  he  had  received  the  degree 
of  M.D.  in  1676.  The  first  of  these  letters  deals  with 
the  epidemics  of  1676,  of  1678,  and  the  succeeding 
years  (intermittents  again  prevailing  after  1678,  and 
influenza  after  1679),  with  the  administration  of 
Peruvian  bark,  and  the  treatment  of  rheumatism  by 
lenitives  and  by  simple,  cool,  nutritious  diet,  such  as 
whey.  The  second  letter  deals  with  venereal  disease. 
Sydenham  noted  that  venereal  lues  had  declined  in 
strength  since,  in  1493,  it  had  first  struck  root  in 


SCIENCE  AND  PRACTICE          155 

Europe,  it  being  in  his  opinion  characteristic  of  spe- 
cies of  disease  that  they  are  modified  in  the  course 
of  time,  that  they  become  extinct  and  give  rise  to 
new  species.  He  recognized  the  primary  lesion  — 
"shanker";  called  buboes  the  first  stage  of  true 
lues;  and  spoke  of  the  disease  as  extending  to  differ- 
ent parts  of  the  body,  attacking  the  bones,  produc- 
ing phagedaenic  ulcers,  etc.  The  taint  of  either 
parent  may  be  transmitted  to  the  offspring.  A  child 
may  communicate  it  to  the  nurse,  or  an  infected 
nurse  may  give  it  to  a  healthy  child.  Sydenham 
knew  that  syphilis,  which  he  differentiated  to  some 
extent  from  gonorrhoea,  had  reached  Europe  after 
the  discovery  of  America,  but  he  held  that  its  origi- 
nal home  was  not  the  West  Indies,  but  the  coast  of 
Guinea  or  some  portion  of  the  negro  country  there- 
about. In  fact,  he  thought  it  identical  with  the  Afri- 
can disease  called  the  "yaws."  Some  argue,  says 
Sydenham,  "that  the  cure  of  the  venereal  disease 
should  not  be  taught.  With  such  I  disagree.  If  we 
reject  all  cases  of  affliction  which  the  improvidence 
of  human  beings  has  brought  upon  themselves,  there 
will  be  little  room  left  for  the  exercise  of  mutual  love 
and  charity.  God  alone  punishes.  We,  as  we  best 
can,  must  relieve.  Neither  must  we  be  too  curious 
in  respect  to  causes  and  motives,  nor  too  vexatious 
in  our  censorship."  According  to  his  experience 
there  was  no  true  instance  of  this  disease  having 


156    THE  HISTORY  OF  MEDICINE 

been  extirpated  except  by  means  of  salivation  ex- 
cited by  mercury. 

Further  claims  on  our  admiration  of  the  clinical 
acumen  and  skill  of  the  English  Hippocrates  are 
made  by  his  recognition  of  the  protean  character  of 
hysteria  and  the  relation  of  hysteria  and  hypochon- 
driasis,  by  his  account  of  scarlatina,  by  his  differen- 
tiation of  chorea  from  dancing  mania,  by  his  riding 
treatment  for  phthisis,  by  his  classical  description 
of  gout  and  other  chronic  diseases.  He  described  a 
species  of  insanity  following  prolonged  malaria. 
Nor  should  we  be  misled  by  exaggerated  statements 
of  his  indifference  to  the  science  of  his  time;  for  he 
refers  repeatedly  to  the  circulation  of  the  blood, 
mentions  the  lacteals,  speaks  appreciatively  of  his 
English  contemporaries  who  "have  done  good  work 
in  each  kind  of  science  that  advances  medicine,"  and 
held  it  essential  for  the  physician,  as  for  the  surgeon, 
to  know  thoroughly  the  structure  of  the  human 
body.  He  was  not  ignorant  of  contemporary  studies 
of  the  anatomy  of  the  kidneys,  and  he  was  aware  of 
the  encystment  of  renal  calculi.  He  said  that  coma 
arises  from  an  obstruction  in  the  cortex  of  the  brain, 
and  that  apoplexy  may  be  caused  by  an  extravasa- 
tion of  blood  from  the  capillaries  of  the  cerebral 
arteries,  and  in  his  treatise  on  dropsy  he  made  men- 
tion of  the  results  of  post-mortem  examination  of 
the  abdomen.  The  special  province  of  the  physician, 


SCIENCE  AND  PRACTICE          157 

however,  is  not,  in  the  judgment  of  Sydenham, 
scientific  research.  It  is  rather  comparable  with 
that  of  a  pilot  whose  only  business  it  is  to  see  that 
the  ship  be  not  sunk,  not  to  speculate  on  the  ebb 
and  flow  of  the  tide.  The  great  English  physician's 
consecration  to  the  welfare  of  his  patients,  as  well 
as  to  the  Commonwealth,  was  a  great  factor  in  the 
establishment  of  his  fame  both  in  Britain  and  on  the 
Continent  of  Europe.  Boerhaave  is  said  never  to 
have  referred  to  Sydenham  without  removing  his 
cap  in  salutation  to  "Angliae  lumen,  artis  Phcebum, 
veram  Hippocratici  viri  speciem." 

Hermann  Boerhaave  himself,  born  near  Leyden, 
Holland,  in  1668,  is  sometimes  called  the  Batavian 
Hippocrates.  Like  his  Greek  and  English  models  he 
was  discriminating  in  the  use  of  drugs  and  made 
much  of  hygiene.  He  was  a  profound  scholar,  and 
served  for  years  as  professor  and  rector  in  the  Uni- 
versity of  Leyden.  His  numerous  pupils,  among 
whom  were  Pringle,  Haller,  Camper,  van  Swieten, 
and  de  Haen,  greatly  extended  the  range  of  his  in- 
fluence. He  is  especially  deserving  of  remembrance 
as  a  clinical  instructor.  At  his  demonstrations  he 
concentrated  attention  on  a  few  patients,  made  use 
of  a  Fahrenheit  thermometer,  and  he  also  sought  to 
verify  his  diagnoses  by  post-mortems,  explaining 
the  pathological  as  a  deviation  from  the  physiologi- 
cal. Like  Sydenham  he  condemned  philosophers 


158    THE  HISTORY  OF  MEDICINE 

who  seek  to  invent  rather  than  to  discover,  but  he 
was  in  closer  touch  with  the  science  of  his  own  time 
than  the  English  physician  had  been  with  that  of 
the  previous  epoch.  He  taught  botany  and  devel- 
oped the  botanical  garden  at  Leyden.  He  was  the 
author  of  a  work  on  chemistry  ("  Elementa Chemise," 
I732)>  m  which  he  taught  that  unlike  combines 
with  unlike,  not  like  with  like.  He  studied  Boyle, 
Malpighi,  Leeuwenhoek,  and  edited  under  the  title 
"Biblia  Naturae"  the  writings  of  Swammerdam, 
who  had  described  red-blood  corpuscles  and  had 
opposed  the  ancient  doctrine  of  spontaneous  genera- 
tion. Boerhaave  maintained  that  epidemics  of  small- 
pox are  owing  solely  to  contagion,  and  he  showed  a 
greater  faith  than  Sydenham  in  the  power  of  the 
human  mind  to  arrive  at  the  ultimate  causes  of 
disease.  "He  who,"  writes  Boerhaave,  "with  the 
greatest  possible  exactness,  weighs  every  particular 
thing  which  shall  happen  or  has  happened  to  his 
patient,  and  which  may  be  learned  from  the  obser- 
vations of  himself  or  of  others,  and  who  then  com- 
pares all  these  with  one  another,  and  places  them  in 
opposition  to  such  things  as  occur  in  a  state  of  health, 
and  finally,  from  all  this,  with  the  nicest  and  strict- 
est control  of  his  speculative  powers,  rises  to  the 
knowledge  of  the  first  cause  of  the  disease,  and  of 
the  remedies  fit  to  remove  it,  he,  and  only  he,  de- 
serves the  name  of  a  true  physician." 


SCIENCE  AND  PRACTICE          159 

One  of  his  critics  regrets  that  Boerhaave,  pos- 
sessed of  remarkable  powers  of  observation,  should 
at  times  have  tied  himself  to  groundless  hypotheses, 
in  opposition  to  the  very  principles  which  he  advo- 
cated so  strongly.  His  works  are  now  little  read,  but 
his  pupils  and  the  record  of  his  enormous  private 
practice  bear  witness  to  his  qualities  as  teacher  and 
physician.  A  monument  raised  in  his  honor  by  the 
city  of  Leyden  is  inscribed:  "Sacred  to  the  Genius  of 
the  Health-giving  Boerhaave  (Salutifero  Boerhaavii 
Genio  Sacrum)." 

REFERENCES 

Boyle,   Robert:    Works   (edited  by  Thomas  Birch).   London, 

1772.  Vol.  v,  pp.  38  and  74-126. 
Brown,  J.:    Spare  Hours  (Horce  Subseciva),  third  series,  1882, 

pp.  39-110,  and  pp.  221-33. 
Lusk,  W.  T.:   "The   Illustrious  Boerhaave,"  Popular  Science 

Monthly,  vol.  47  (1895),  pp.  110-20. 
*"  Osier,  Sir  William,  and  McCrae,  Thomas:    The  Principles  and 

Practice  of  Medicine.   Ninth  edition,  1920,  pp.  320-30. 
Payne,  J.  F.:   Thomas  Sydenham.   New  York,  1900. 
Picard,  Frederic:  Sydenham,  sa  Vie,  ses  (Euvres.  Paris,  1889. 
Sydenham,  Thomas:  Works  (translated,  with  a  life  of  the  author 

by  R.  G.  Latham).  2  vols.,  1848  and  1850.  Published  by  The 

Sydenham  Society. 
Creighton,  Charles:  A  History  of  Epidemics  in  Britain.    2  vols. 

Cambridge,  1891  and  1894. 
Prinzing,   Friedricb:    Epidemics  Resulting  from   Wars.  Oxford 

(Clarendon  Press),  1916. 


.CHAPTER  VIII 
COMPARATIVE  ANATOMY:  JOHN  HUNTER 

JOHN  HUNTER,  born  near  Glasgow  in  1728,  was,  like 
Darwin,  an  indefatigable  collector  of  natural  history 
specimens.  As  a  boy,  instead  of  going  to  school,  he 
wandered  about  the  country,  observing  the  ants, 
the  bees,  the  tadpoles,  and  the  larvae  of  caddis-flies, 
studying  the  habits  of  the  birds,  and  making  collec- 
tions of  birds'  eggs,  which  he  compared  in  size,  color, 
markings,  and  in  the  number  characteristic  of  each 
species.  In  his  twenty-first  year  he  began  at  London 
those  studies  in  anatomy  and  surgery  which  formed 
the  basis  of  his  subsequent  activities.  After  eleven 
or  twelve  years  of  almost  unremitting  work  in  the 
dissecting-room  and  the  hospital,  he  went,  as  sur- 
geon, with  the  military  expedition  to  Belle-He, 
where  he  collected  specimens  which  formed  the 
nucleus  of  what  is  now  known  as  the  Hunterian  Mu- 
seum. Service  in  Portugal  gave  him  the  opportunity 
of  extending  his  observations.  In  1764  he  estab- 
lished at  Earl's  Court,  at  that  time  well  to  the  west 
of  the  city  of  London,  a  country-seat  stocked  with 
ducks,  geese,  pigeons,  fish,  frogs,  eels,  river-mussels, 
sheep  from  Turkey,  a  shawl-goat  from  the  East 
Indies,  buffaloes,  leopards,  a  beautiful  little  bull 


COMPARATIVE  ANATOMY        161 

presented  by  the  Queen,  and  specimens  of  various 
other  species,  plant  as  well  as  animal.  His  town 
house  became  crammed  with  natural  history  speci- 
mens, so  that,  soon  after  his  marriage  in  1771,  his 
bride,  the  accomplished  Anne  Home,  found  herself 
living  either  in  a  menagerie  in  the  country  or  in  a 
museum  in  the  city.  In  1783  he  set  up  his  famous 
establishment  in  Leicester  Square.  He  held  that 
Francis  Bacon  had  been  the  chief  cause  of  the  ad- 
vance of  science  since  the  sixteenth  century,  and  he 
determined  to  base  his  own  generalizations  on  com- 
prehensive and  careful  observation  of  natural  phe- 
nomena. Animals  dying  at  the  Tower  of  London 
and  the  city  menageries  were  obtained  by  Hunter 
for  dissection,  and  no  animal  was  brought  to  Eng- 
land during  the  latter  part  of  his  career  without  his 
having  an  opportunity  to  examine  it. 

Hunter  lacked  Darwin's  opportunity  of  extended 
travel,  but  the  material  brought  to  his  door  offered 
an  equivalent  in  some  respects,  and  he  lived  in  an 
age  when  men's  imaginations  were  kindled  by  voy- 
ages of  discovery  as  they  had  been  in  the  Eliza- 
bethan. In  1771  Edward  Jenner,  Hunter's  pupil 
and  familiar  friend,  was  chosen  at  his  suggestion  to 
examine  and  classify  the  collections  brought  to  Eng- 
land by  Captain  Cook  from  Australia,  New  Zealand, 
and  other  islands  of  the  South  Pacific. 

This  incident  serves  to  indicate  the  kind  of  influ- 


162     THE  HISTORY  OF  MEDICINE 

ence  exerted  on  Jenner  by  his  master.  It  is  indeed 
true  that  Hunter  was  interested  in  the  problem  of 
immunity  and  in  the  rivalry  of  diseases.  He  knew 
that  people  constantly  exposed  to  the  cause  of  cer- 
tain diseases  become  less  affected,  or  less  liable  to  be 
affected.  He  recorded  the  case  of  two  children,  in 
which  smallpox,  following  inoculation,  was  held  in 
abeyance  for  a  time  by  an  attack  of  measles.  He 
said  that  cowpox  and  smallpox,  if  inserted  at  the 
same  time  in  different  parts  of  the  same  person,  pro- 
duce each  the  same  effect  as  if  only  one  of  them  had 
been  inserted.  Nevertheless,  Jenner's  indebtedness 
to  Hunter  has  sometimes  been  put  in  a  false  light, 
and  Hunter's  famous  exhortation  to  his  pupil  to  rely 
on  experiment  rather  than  on  speculation  or  au- 
thority referred  to  a  problem  in  natural  history  and 
not  to  vaccination.  "I  thank  you,"  wrote  Hunter, 
"for  your  experiment  on  the  hedgehog;  but  why  do 
you  ask  me  a  question  by  the  way  of  solving  it?  I 
think  your  solution  is  just;  but  why  think  —  why 
not  try  the  experiment?"  About  three  years  later, 
that  is,  in  1778,  Hunter  turns  suddenly  from  a  dis- 
cussion of  Jenner's  disappointment  in  love  to  stimu- 
late him  to  undertake  fresh  experiments  on  hiber- 
nating animals.  "I  own,"  he  writes,  "I  was  glad 
when  I  heard  you  was  married  to  a  woman  of  for- 
tune; but  'let  her  go,  never  mind  her.'  I  shall  em- 
ploy you  with  hedgehogs."  Again  he  writes:  "I 


COMPARATIVE  ANATOMY        163 

have  but  one  order  to  send  you,  which  is,  send  every- 
thing you  can  get,  whether  animal,  vegetable,  or 
mineral,  and  the  compound  of  the  two;  namely, 
either  animal  or  vegetable  mineralized." 

His  cupidity  for  Nature  was  never  satiated.  At 
considerable  expense  he  sent  a  surgeon  to  Greenland 
to  examine  the  anatomical  structure  of  large  marine 
animals  and  to  preserve  the  more  interesting  parts. 
In  1793,  the  year  of  his  death,  his  zeal  in  the  study 
of  Nature  was  still  undiminished.  Writing  to  a 
gentleman  in  Africa  he  asked  for  specimens  of  the 
different  species  of  swallows,  in  order  that  he  might 
obtain  a  clue  to  their  migrations,  everything  re- 
specting the  bee  tribe,  such  as  wasps  with  their 
nests,  also  hornets  with  theirs,  cuckoos,  ostrich- 
eggs,  and  chameleons.  "If  a  Foal  camell  was  put 
into  a  tub  of  spirits  and  sent,  I  should  be  glad.  Is  it 
possible  to  get  a  young  tame  lion,  or  indeed  any 
other  beast  or  Bird." 

Hunter's  writings  along  with  the  specimens  pre- 
served in  his  museum  show  that  he  had  dissected 
twenty-one  species  of  quadrumana  (apes,  monkeys, 
lemurs),  ten  species  of  marsupials,  fifty-one  species 
of  carnivora,  twenty  species  of  rodents,  five  species 
of  edentata,  fifteen  species  of  ruminants,  ten  species 
of  pachyderms,  six  species  of  cetacea,  and  twenty- 
three  other  species  of  mammals  scattered  through 
the  sub-classes.  As  regards  human  anatomy  Hunter 


164     THE  HISTORY  OF  MEDICINE 

dissected  thousands  of  cadavers.  There  is  like  evi- 
dence that  he  dissected  one  hundred  species  of  birds, 
fifty-nine  species  of  fish,  thirty-nine  species  of 
reptiles,  forty-two  species  of  molluscs,  over  ninety 
species  of  "articulate"  and  "radiate"  animals,  and, 
in  addition,  twenty  miscellaneous  species  of  inverte- 
brates. His  museum  contained  13,682  specimens, 
including  2773  fossils. 

Sir  Richard  Owen,  the  leading  authority  on  com- 
parative anatomy  in  the  period  following  the  death 
of  Cuvier,  credits  Hunter  with  the  first  great  at- 
tempt to  arrange  in  concatenated  system  the  di- 
versified facts  of  that  branch  of  science.  The  idea  of 
a  graded  series  is  a  constant  feature  of  Hunter's 
studies  of  the  various  anatomical  structures,  as  well 
as  of  his  attempts  to  lay  the  foundations  of  a  phylo- 
genetic  classification  of  animals.  He  considered,  for 
example,  whatever  is  uncommon  in  the  organ  of 
hearing  in  fishes  as  only  a  link  in  the  chain  of  varie- 
ties displayed  in  the  organ  of  like  function  in  differ- 
ent animals,  descending  from  the  most  perfect  to  the 
most  imperfect,  in  a  regular  progression.  Guided  by 
the  same  principle  he  traced  the  development  of  the 
nervous  system  from  the  simple  filaments  of  some 
of  the  lower  organisms  to  the  highly  organized 
masses  found  in  the  monkey  and  in  man,  the  most 
complex  of  the  animals.  In  like  manner  he  followed 
the  development  of  the  canine  teeth,  which  he  was 


COMPARATIVE  ANATOMY        165 

the  first  to  call  cuspids,  from  the  lion  to  man,  noting 
the  similarity  in  shape,  situation,  and  function. 
Palmer,  who  edited  Hunter's  works  in  1837,  took 
him  to  task  for  teaching  that  man  was  originally 
constructed  for  the  pursuit  and  capture  of  living 
prey.  Though  the  criticism  may  have  been  well 
founded,  it  should  be  recognized  that  Hunter  dis- 
tinctly taught  that  man,  a  more  perfect  or  compli- 
cated animal  than  any  other,  is  not  made  to  come 
at  his  food  by  his  teeth,  but  by  his  hands,  directed 
by  his  superior  ingenuity;  also,  that  man  is  able  to 
live  in  a  much  greater  variety  of  circumstances  than 
any  other  animal,  has  more  opportunities  of  exer- 
cising the  faculties  of  his  mind,  and  is  possessed  of 
that  high  degree  of  sociability  which  implies  superior 
educability. 

In  tracing  the  affinities  of  the  different  species  of 
animals  Hunter  supplemented  his  special  studies  of 
anatomical  structure  —  for  example,  of  the  whale 
as  a  modified  land  animal,  of  the  relationship  of 
birds  and  batrachians,  of  the  weak  wings  and  highly 
developed  legs  of  the  ostrich  —  by  common-sense 
observation  as  well  as  by  experiment.  He  did  not 
overlook  the  obvious  resemblance  of  the  horse,  the 
ass,  and  the  zebra,  nor  that  of  the  wolf,  dog,  jackal, 
and  dingo.  Does  not  the  natural  gradation  of  ani- 
mals from  one  to  the  other,  he  asks,  lead  to  the 
original  species?  The  wolf  has  a  closer  resemblance 


166     THE  HISTORY  OF  MEDICINE 

to  the  fox  than  has  either  the  dog  or  the  jackal.  The 
shepherd's  dog,  all  over  the  world,  as  well  as  the 
Esquimaux  dog  and  the  dingo,  resembles  the  wolf 
in  shape  and  disposition.  Hunter  owned  one  of  a 
litter  of  puppies,  the  offspring  of  a  wolf  and  a  bitch. 
He  described  it  as  easily  startled  and  particularly 
apprehensive  of  danger.  It  had  the  shape  of  the 
wolf  refined,  and  a  long  coat  almost  as  fine  as  that  of 
the  black  fox.  The  mother  was  of  the  Pomeranian 
breed.  A  bitch  of  this  same  litter  had  in  all  thirty- 
five  puppies,  some  of  which  were  wild  and  so  unruly 
that  they  could  not  be  controlled  by  the  most  skill- 
ful dog-trainers.  Hunter  records  another  case  of 
four  puppies,  the  offspring  of  a  she-wolf  and  a  grey- 
hound. Two  were  like  the  dog  in  color  —  large 
black  spots  on  white  ground;  one  was  black;  the 
fourth  was  dun,  and  would  probably  have  been  like 
the  mother.  Hunter  owned  a  puppy  of  a  second 
litter  of  this  she-wolf.  He  also  secured  a  female 
puppy  of  a  she-jackal  and  a  spaniel.  It  was  of  a 
wild  disposition.  When  mature  it  gave  birth  to  five 
puppies.  One  of  these  was  given  to  Jenner,  who 
subsequently  reported  that  it  was  shy  and  appre- 
hensive, and  remarkably  fleet. 

Hunter's  posthumous  essays  show  with  what  care 
he  compared  the  anatomical  structure  of  apes, 
monkeys,  and  lemurs  with  that  of  man.  In  a  species 
of  gibbon  he  observed  the  absence  of  the  tail,  the 


COMPARATIVE  ANATOMY        167 

length  of  the  appendix,  as  well  as  the  similarity  of 
the  liver  and  other  abdominal  viscera  to  those  of  a 
human  being.  The  uterus  in  form  and  position  is 
like  that  of  a  child.  In  one  species  of  Macacus  he 
found  that  the  muscles  of  the  eye  are  as  in  man,  and 
that  the  brain  is  very  like  the  human.  In  another 
species  of  monkey  he  noted  that  the  prostate  gland 
is  similar  to  the  human  prostate  gland.  "The 
monkey,"  says  Hunter,  "in  general  may  be  said  to 
be  half  beast  and  half  man ;  it  may  be  said  to  be  the 
middle  stage."  Again  he  described  the  mongoose  as 
an  exact  degree  from  the  monkey  to  the  brute  in  its 
external  form. 

Hunter  supposed  that  the  erect  posture  in  man 
rendered  him  more  liable  to  rupture,  and  contrib- 
uted to  the  descent  of  the  testes.  When  the  testes 
remain  in  the  abdomen  in  man,  as  they  do  normally 
in  the  hedgehog  and  some  other  species  of  animals, 
we  have  an  example  of  what  Hunter  was  the  first  to 
call  "arrested  development."  The  erect  posture 
accounted  likewise  in  his  judgment  for  the  disposi- 
tion of  the  pelvic  viscera  in  man,  and  affected  the 
curves  of  the  spine  and  the  form  of  the  foot,  as  well 
as  the  structure  of  the  knee-joint.  He  noted  the 
differentiation  of  the  hand  from  the  foot  in  man  and 
monkey.  He  believed  that  the  thumb  of  the  monkey 
is  not  so  strong  as  that  of  man,  "and  has  not  that 
opposing  motion."  The  walk  of  the  monkey  is  very 


1 68      THE  HISTORY  OF  MEDICINE 

similar  to  that  of  a  child  who  has  hardly  the  power 
of  supporting  the  center  of  gravity,  he  says. 

Hunter  had  observed  at  Belle-He  that  frogs  live 
upon  worms,  beetles,  grasshoppers,  caterpillars,  and 
butterflies.  Later  he  attained  to  the  generalization 
that  the  large  animals  are  made  as  a  rule  to  live 
upon  the  less,  and  he  anticipated  the  doctrines  of 
Malthus  so  far  as  to  teach  that  it  is  necessary  "that 
many  animals  should  be  made  to  prey  upon  others ; 
else  we  should  be  overstocked  with  the  smaller." 
He  also  held  that  modifications  that  occur  in  animal 
structure  tend  to  progression  rather  than  to  retro- 
gression. Deviation  from  the  original  structure  is 
not  necessarily  deterioration.  It  appears,  he  remarks, 
just  the  contrary;  therefore  we  may  suppose  that 
nature  is  improving  its  works,  or,  at  least,  has  estab- 
lished the  principle  of  improvement  in  the  body  as 
well  as  in  the  mind.  Variation  furnishes  the  mate- 
rials of  advance.  In  the  individuals  of  each  species, 
writes  Hunter,  varieties  are  every  day  produced  in 
color,  shape,  size,  and  disposition.  Some  of  these 
changes  are  permanent  with  respect  to  the  propaga- 
tion of  the  animal,  becoming  so  far  a  part  of  its 
nature  as  to  be  continued  in  the  offspring.  In  the 
case  of  acquired  properties,  according  to  Hunter,  it 
is  only  the  susceptibility  to  certain  influences  that  is 
inherited.  Diseases  like  gout  and  scrofula  are  not 
really  hereditary. 


COMPARATIVE  ANATOMY        169 

He  remarked,  in  his  comparative  study  of  the 
gizzard  and  stomach,  the  difficulty  generally  en- 
countered by  the  anatomist  of  distinguishing  the 
proximate  steps  in  the  slow  and  imperceptible  grada- 
tions of  nature.  His  recognition  of  the  gradual 
deviation  from  type  as  the  rule  did  not  blind  him, 
however,  to  the  possibility  of  exceptions.  "How 
far,"  he  says,  "varieties  in  animals  are  gradual,  or 
in  what  degree  they,  at  once,  produce  a  very  dis- 
tinct variety,  is  perhaps  not  to  be  ascertained."  He 
mentions  the  case  of  a  white  negress  who  had  three 
children  by  a  white  man.  One  of  the  children  was 
black,  while  the  two  others  were  tawny.  Hunter 
was  interested  of  course  in  atavism,  and  in  the  varia- 
tions that  occur  in  domesticated  animals.  He  speaks 
of  latent  hereditary  dispositions,  which  pass  over 
one  or  two  generations,  and  start  up  again  in  the 
second  or  third.  Again,  animals  living  in  a  free  and 
natural  state  are  subject  to  fewer  deviations  from 
their  specific  characters  than  are  animals  influenced 
by  culture.  "From  the  variations  produced  by  cul- 
ture, it  would  appear,  that  the  animal  is  so  suscepti- 
ble of  impression,  as  to  vary  nature's  actions  and 
this  is  even  carried  into  propagation." 

In  1766,  the  year  preceding  that  in  which  Hunter 
became  a  fellow  of  the  Royal  Society,  he  wrote  a 
description  of  the  anatomy  of  an  Amphibious  Bipes, 
a  species  of  Siren,  which  had  defied  the  classificatory 


i;o     THE  HISTORY  OF  MEDICINE 

skill  of  Linnseus.  It  was  animals  like  this  and  the 
Southern  Chimera,  which  did  not  seem  to  fit  into 
the  pigeon-holes  of  the  System  of  Nature,  that  par- 
ticularly fascinated  Hunter.  He  was  deeply  inter- 
ested not  only  in  exceptional  species  of  all  sorts,  but 
in  giants,  dwarfs,  hermaphrodites,  and  other  mon- 
strosities. According  to  Owen  he  anticipated  the 
principles  set  forth  by  Isidore  Geoffroy  Saint- 
Hilaire  in  his  "Traite  de  Teratologie"  (1832). 
Hunter  observed  that  the  natural  hermaphrodite 
belongs  to  the  inferior  and  more  simple  genera  of 
animals,  of  which  there  is  a  much  greater  number 
than  of  the  more  perfect;  and  as  animals  become 
more  complicated,  have  more  parts,  and  each  part  is 
more  confined  to  its  particular  use  [by  a  physiologi- 
cal division  of  labor] ,  a  separation  of  the  two  neces- 
sary powers  for  generation  seems  also  to  take  place. 
He  raised  the  question  whether  there  ever  occurs  in 
the  genera  of  animals  that  are  natural  hermaphro- 
dites, a  separation  of  the  two  parts  forming  distinct 
sexes,  and  he  conjectured  that  the  occurrence  of 
such  a  variation  might  account  for  the  distinction 
of  sexes  ever  having  happened. 

Darwin  begins  Part  II  of  "The  Descent  of  Man" 
with  the  following  statement:  "With  animals  which 
have  their  sexes  separated,  the  males  necessarily 
differ  from  the  females  in  their  organs  of  reproduc- 
tion; and  these  are  the  primary  sexual  characters. 


COMPARATIVE  ANATOMY        171 

But  the  sexes  often  differ  in  what  Hunter  has  called 
secondary  sexual  characters,  which  are  not  directly 
connected  with  the  act  of  reproduction."  A  glance 
at  the  table  of  contents  of  this  work  of  Darwin's  will 
convince  the  reader  that  Hunter's  conception  is  the 
dominant  idea  of  the  last  two  thirds  of  it.  An  in- 
troductory chapter  on  the  principles  of  sexual  selec- 
tion is  followed  by  chapters  on  secondary  sexual 
characters  in  the  lower  classes  of  the  animal  king- 
dom —  in  insects,  in  lepidoptera,  in  fishes,  amphib- 
ians, reptiles,  in  birds,  and  in  mammals.  The  third 
and  last  part  of  "The  Descent  of  Man"  consists  of 
two  chapters  on  the  secondary  sexual  characters  of 
man  and  a  general  summary  and  conclusion.  "In 
all  animals  we  are  acquainted  with,"  writes  Hunter, 
"  we  see  distinguishing  marks  between  the  male 
and  female,  exclusive  of  the  parts  peculiar  to  each." 
Hunter  divides  sexual  characters  into  principal 
and  secondary,  and  among  the  secondary  properties 
which  characterize  the  male  and  the  female  he 
mentions  the  beard,  mane,  spurs,  horns,  voice,  etc. 
He  carefully  records  cases  in  which  the  female 
pheasant  had  assumed  the  plumage  of  the  male.  He 
also  refers  to  an  interesting  case  in  which  the  mam- 
mary glands  were  fully  functional  in  a  man. 

Owen  says  that  Hunter  was  the  first  to  enunciate 
the  principle  of  the  resemblance  of  the  phases  of 
embryonic  life  to  the  series  of  inferior  forms  of  ani- 


172     THE  HISTORY  OF  MEDICINE 

mal  species.  "If,"  wrote  Hunter,  "we  were  capable 
of  following  the  progress  of  increase  of  the  number 
of  the  parts  of  the  most  perfect  animal,  as  they  first 
formed  in  succession,  from  the  very  first  to  its  state 
of  full  perfection,  we  should  probably  be  able  to 
compare  it  with  some  one  of  the  incomplete  animals 
themselves,  of  every  order  of  animals  in  the  creation, 
being  at  no  stage  different  from  some  of  the  inferior 
orders.  Or,  in  other  words,  if  we  were  to  take  a 
series  of  animals,  from  the  more  imperfect  to  the 
perfect,  we  should  probably  find  an  inferior  animal, 
corresponding  with  some  stage  of  the  most  perfect." 
This  idea,  with  which  Hunter  was  struggling,  has 
been  neatly  expressed  in  our  times  by  saying  that 
the  human  embryo  in  each  of  its  stages  of  develop- 
ment resembles  the  mature  form  of  some  species 
lower  than  itself.  Of  course  this  generalization  of 
Hunter's  rested  on  numerous  observations.  He  re- 
marked, as  we  have  seen,  that  in  the  hedgehog  the 
testes  continue  throughout  life  to  be  lodged  in  the 
abdomen,  in  the  same  position  as  in  the  human 
fcetus.  The  appendix  of  a  species  of  lemur  is  like 
that  structure  in  the  human  fcetus,  which,  in  turn, 
Hunter  compared  with  the  fcetal  appendix  of  the 
monkey.  The  resemblance  of  the  disposition  of  the 
abdominal  viscera  in  the  lower  mammals  in  general 
with  that  in  the  human  fcetus  is  another  case  in 
point.  Congenital  hernia  and  certain  other  ab- 


COMPARATIVE  ANATOMY        173 

normalities  were  explained  by  Hunter  as  persisting 
embryonic  conditions. 

Geology  afforded  him  another  clue  to  the  affini- 
ties of  the  various  species  and  genera  of  animals,  as 
well  as  to  the  interdependence  of  natural  and  physi- 
cal phenomena.  He  agreed  with  Hutton  that  geology 
has  nothing  to  do  with  the  original  formation  of  the 
earth  itself,  but  is  concerned  only  with  the  changes 
of  the  earth's  crust.  Hutton,  as  Lyell  remarks,  pos- 
sessed little  information  regarding  organic  remains. 
Hunter,  on  the  other  hand,  before  the  appearance  of 
Hutton's  "Theory  of  the  Earth,"  was  attempting 
to  match  up  fossil  animals  with  those  living  species 
with  which  he  was  so  eminently  conversant.  He 
distinctly  taught  that  we  should  be  unable  to  con- 
sider the  operations  affecting  the  surface  of  the 
earth  if  we  had  not  the  preserved  parts  of  animals 
to  guide  us.  They  enable  us  to  trace  the  history  of 
the  earth's  crust  just  as  we  should  trace  the  political 
events  in  any  country  by  the  monuments  left.  We 
must  judge  of  the  past  by  the  present,  supposing 
from  the  state  of  the  earth  as  it  now  is  what  must 
have  taken  place  formerly. 

Hunter  further  agreed  with  the  uniformitarians 
in  believing  in  the  antiquity  of  the  earth.  Speaking 
of  one  collection  of  fossil  bones  he  says  that  there 
was  probably  a  succession  of  them  for  a  vast  series 
of  years,  many  thousand  years.  In  what  was  sup- 


174     THE  HISTORY  OF  MEDICINE 

posed  ly  the  last  essay  he  wrote  he  used  the  expres- 
sion "many  thousand  centuries."  This  was  criticized 
and  a  representative  of  the  Royal  Society  suggested 
that  he  substitute  "years"  for  "centuries,"  but  he 
withdrew  the  paper  rather  than  make  the  change. 

Few  fossils,  says  Hunter,  correspond  with  recent 
specimens.  They  may  not  be  of  different  species, 
but  varieties  of  the  same  species.  If  they  are  really 
different  species,  then  we  must  suppose  the  old  are 
lost  and  that,  therefore,  a  new  creation  must  have 
taken  place.  That  many  are  actually  lost  seemed 
plainly  shown  by  the  remains  of  land  animals  that 
are  not  now  known.  How  they  became  extinct  is  not 
easily  accounted  for.  His  unexcelled  knowledge  of 
dentition  enabled  him  to  identify  a  fossil  white  bear 
twice  as  large  as  the  present  white  bear,  and  gave 
him  assurance  that  the  fossil  teeth  found  at  Salt 
Lick,  near  the  Ohio,  about  1767,  belonged  to  an  ani- 
mal larger  than  the  elephant. 

The  teeth  of  the  kangaroo  are  so  singular  that  it 
is  impossible  from  them  to  say  what  tribe  it  is  of.  At 
the  same  time  Hunter  was  not  unaware  of  the  mar- 
supial character  of  the  Australian  fossil  mammalia. 
Darwin,  in  that  part  of  the  "Origin  of  Species"  that 
treats  of  geological  succession,  pays  tribute  to  the 
work  of  Hunter  by  referring  to  his  faithful  followers 
Clift  and  Owen.  "  Mr.  Clift,"  writes  Darwin,  "many 
years  ago  showed  that  the  fossil  mammals  from  the 


COMPARATIVE  ANATOMY        175 

Australian  caves  were  closely  allied  to  the  living 
marsupials  of  that  continent.  In  South  America,  a 
similar  relationship  is  manifest,  even  to  an  unedu- 
cated eye,  in  the  gigantic  pieces  of  armor  like  those 
of  the  armadillo,  found  in  several  parts  of  La  Plata; 
and  Professor  Owen  has  shown  in  the  most  striking 
manner  that  most  of  the  fossil  mammals,  buried 
there  in  such  numbers,  are  related  to  South  Ameri- 
can types."  Hunter  had  dissected  of  course  arma- 
dillos, sloths,  and  ant-eaters,  and  other  specimens 
of  South  American  species  that  proved  of  interest 
to  Owen  and  Darwin. 

William  Gift,  the  last  and  most  devoted  of 
Hunter's  pupils,  was  received  as  an  apprentice  and 
amanuensis  on  his  seventeenth  birthday,  February 
14,  1792.  After  Hunter's  death,  in  the  autumn  of 
the  following  year,  Clift  was  placed  in  charge  of  the 
establishment  in  Leicester  Square.  Almost  the  sole 
occupant  of  the  large  building  during  the  subse- 
quent six  years,  he  spent  his  time  studying  the  speci- 
mens in  the  museum  and  making  extensive  excerpts 
from  his  master's  volumes  of  unpublished  manu- 
scripts. When,  in  1800,  the  museum  was  taken  over 
by  the  College  of  Surgeons  and  the  collections  were 
removed  to  new  quarters,  Clift  was  continued  in 
charge  with  the  title  of  Conservator.  The  greater 
part  of  Hunter's  manuscripts  were  destroyed  by  his 
brother-in-law,  Sir  Everard  Home,  in  1823.  In  1830 


176     THE  HISTORY  OF  MEDICINE 

Richard  Owen,  who  had  studied  under  Hunter's 
pupil  Abernethy,  was  appointed  Clift's  assistant. 
"From  Clift,"  says  the  "Dictionary  of  National 
Biography,"  "Owen  imbibed  an  enthusiastic  rever- 
ence for  his  great  master,  John  Hunter,  which  was 
continually  augmented  by  closer  study  of  his 
works."  Owen  married  Clift's  daughter  in  1835,  and 
helped  Palmer  edit  Hunter's  works.  The  paper,  al- 
ready referred  to  as  probably  Hunter's  last  essay, 
"On  Extraneous  Fossils  and  their  Relations,"  was 
not  published  till  1859,  a  few  months  after  the  ap- 
pearance of  the  "Origin  of  Species."  In  1861  Owen 
published  from  Clift's  notes  two  volumes  under  the 
title  "Essays  and  Observations  in  Natural  History, 
Anatomy,  Physiology,  Psychology,  and  Geology,  by 
John  Hunter,  being  his  Posthumous  Papers  on  these 
Subjects."  It  was  largely  through  Clift  and  Owen, 
and  visitors  to  the  Hunterian  Museum,  such  as  the 
younger  Meckel  (Johann  Friedrich,  1781-1833)  and 
Cuvier,  that  the  influence  of  John  Hunter  in  com- 
parative anatomy  and  natural  history  was  per- 
petuated. 

Hunter's  attitude  toward  his  profession  was  some- 
what different  from  Sydenham's.  He  regarded 
science  as  the  essential  basis  of  practice,  and  hoped 
by  his  investigations  to  establish  new  methods  of 
treatment,  or,  as  he  said,  to  make  discoveries  in  the 
art  itself.  He  is  now  recognized  as  the  founder  of 


COMPARATIVE  ANATOMY        177 

scientific  surgery.  Many  of  the  reforms  he  effected 
in  his  profession  were  the  direct  result  of  his  com- 
prehensive study  of  natural  phenomena.  "  It  is  con- 
trary to  the  rules  of  surgery  as  founded  on  our 
knowledge  of  the  animal  economy,"  he  writes,  "to 
enlarge  wounds  simply  as  wounds,"  which  had  been 
the  general  practice  before  the  time  of  Hunter.  His 
observation  of  tetanus  in  a  deer  as  the  result  of  a 
compound  fracture  stimulated  his  interest  in  the 
conditions  of  inflammation.  He  removed  one  ovary 
from  a  young  sow,  found  that  it  subsequently  had 
numerous  offspring,  and  stated  his  conviction  that 
there  was  no  reason  why  the  female  of  the  human 
species  should  not  bear  spaying.  His  seemingly 
whimsical  experiments  in  the  transplantation  of 
tissues  have  anticipated  some  of  the  most  striking 
achievements  of  modern  surgery.  In  his  experi- 
ments on  the  temperature  of  animals  he  made  use  of 
a  thermometer  of  his  own  invention  very  similar  to 
the  clinical  thermometer  of  the  present  day.  His 
studies  in  comparative  odontology  enabled  him  to 
observe  the  cause  of  the  retardation  and  the  diffi- 
culty in  cutting  of  the  wisdom  teeth  in  man,  which 
arise,  he  says,  from  the  want  of  room  in  the  jaws  for 
these  late  teeth.  In  fact,  Hunter's  scientific  study  of 
the  teeth  rescued  dentistry  from  a  state  of  crude 
empiricism  and  placed  it,  as  surgery  in  general, 
on  firm  foundations.  One  of  the  most  fruitful  of  his 


1 78     THE  HISTORY  OF  MEDICINE 

investigations  was  his  study  of  the  circulation  in  the 
antlers  of  the  deer.  He  ligated  the  artery  supplying 
the  circulation  in  the  antlers  of  a  buck  in  Richmond 
Park.  The  antlers,  which  were  in  the  velvet,  de- 
prived of  their  blood-supply,  grew  cold.  In  two  or 
three  days,  however,  Hunter  observed  that  the 
temperature  had  become  normal  again,  and  this  he 
attributed  to  the  establishment  of  a  compensatory 
collateral  circulation.  Later  investigation  proved 
that  the  ligated  artery  had  become  obliterated. 

Soon  after  this  experiment  he  applied  his  discov- 
ery in  the  hospital  in  the  treatment  of  a  case  of 
popliteal  aneurism,  tying  the  femoral  artery  in  the 
upper  part  of  the  thigh.  His  example  opened  the 
way  to  the  triumphs  of  British  and  American  vascu- 
lar surgery.  One  must  mention  in  this  connection 
Hunter's  pupil  Astley  Cooper  (the  master  of  John 
Collins  Warren,  who  played  so  large  a  part  in  the 
introduction  of  ether  anaesthesia  and  in  the  founding 
of  the  Massachusetts  General  Hospital,  and  of 
Valentine  Mott,  who  ultimately  had  one  hundred 
and  thirty-eight  ligations  for  aneurism  to  his  credit), 
Hunter's  pupils  Abernethy,  Wright  Post,  and  Phy- 
sick,  the  Father  of  American  Surgery,  as  well  as 
Physick's  nephew,  John  Syng  Dorsey. 

It  is  not  altogether  irrelevant  to  mention  Hunter's 
study  of  gunshot  wounds,  which  gives  him  a  place 
among  the  founders  of  modern  military  surgery,  his 


COMPARATIVE  ANATOMY        179 

study  of  the  repair  of  tendons  and  his  relation  to 
subcutaneous  and  orthopaedic  surgery,  his  influence 
on  the  treatment  of  hernia,  his  observations  on  the 
inflammation  of  veins,  the  clotting  of  blood,  and  the 
communicability  of  puerperal  fever.  Hunter  dis- 
covered the  distribution  of  the  olfactory  nerves,  ex- 
plained the  placental  circulation,  traced  the  course 
of  the  tubuli  uriniferi,  advanced  our  knowledge  of 
the  lymphatic  system,  distinguished  Hunterian 
chancre  from  chancroid  ulcer,  invented  double  bel- 
lows for  the  resuscitation  of  the  apparently  drowned 
and  advocated  the  use  of  oxygen  in  the  treatment  of 
such  cases.  He  experimented  in  artificial  feeding, 
made  a  special  study  of  intussusception,  threw  light 
on  the  nature  of  alcoholic  fermentation,  recorded  a 
case  of  post-mortem  digestion  of  the  tissues  of  the 
stomach,  observed  hydatids  in  the  liver  of  the  mon- 
goose, and  investigated  the  motion  and  the  tempera- 
ture of  plants. 

Hunter  was  interested  in  the  mental  processes 
and  their  development  as  a  part  of  an  interrelated 
system  of  natural  phenomena.  He  studied  color- 
blindness ten  years  before  John  Dalton,  was  inter- 
ested in  the  accommodation  of  the  eyes,  discovered 
what  was  later  called  the  specific  energy  of  the 
nerves,  traced  the  growth  of  the  perception  of  space, 
noted  the  abundance  of  human  instincts,  antici- 
pated modern  psychology  in  reference  to  types  of 


i8o     THE  HISTORY  OF  MEDICINE 

memory  and  imagination  and  the  physiological 
phases  of  the  emotions,  studied  the  expression  of  the 
emotions  in  the  lower  animals,  recognized  the  sur- 
vival value  of  anger  and  fear,  and  wrote  in  an  en- 
lightened way  concerning  what  is  now  called  the 
sublimation  of  the  emotions. 

REFERENCES 

Baron,  J.:  Life  of  Jenner.  2  vols.,  London,  1827-38. 
Gross,  Samuel  David:  John  Hunter  and  his  Pupils.  Philadelphia, 

1881. 
Hunter,  John:   (i)  Essays  and  Observations  on  Natural  History, 

Anatomy,   Physiology,   Psychology,  and   Geology,    being   his 

Posthumous  Papers,  etc.     Edited  by  Richard  Owen.  2  vols., 

London,  1861. 

(2)  Observations  on  Certain  Parts  of  the  Animal  (Economy. 
London,  1792. 

(3)  Works.  Edited  by  J.  F.  Palmer.  London,  1837. 
Ottley,  Drewry:    The  Life  of  John  Hunter.    Philadelphia,  1839. 
Paget,  Stephen:    John  Hunter,  Man  of  Science  and  Surgeon. 

London,  1897. 

Stirling,  William:  Some  Apostles  of  Physiology.   1902. 
Keith,  Sir  Arthur:  Menders  of  the  Maimed. 
Guerini,  Vincenzo:    A  History  of  Dentistry.    Philadelphia  and 

New  York,  1909,  pp.  316,  318,  324. 


CHAPTER  IX 

MORBID  ANATOMY,  AND  HISTOLOGY: 
MORGAGNI,   BICHAT 

WITHINGTON  in  his  "Medical  History"  says  that 
local  pathology,  the  study  of  the  tissues,  and  local 
diagnosis  form  the  three  legs  of  the  tripod  upon 
which  the  genius  of  modern  medicine  took  her  seat. 
The  early  history  of  these  three  —  morbid  anatomy, 
histology  (UTTOS,  tissue),  and  one  aspect  of  local 
diagnosis  —  will  occupy  our  attention  in  this  and  in 
the  following  chapter. 

Giovanni  Battista  Morgagni  (1682-1771)  has 
been  called  the  Father  of  Pathology.  His  book 
"Concerning  the  Seats  and  Causes  of  Diseases  in- 
vestigated by  Anatomy"  ("De  sedibus  et  causis 
morborum  per  anatomen  indagatis,"  1761)  gave  the 
results  of  postmortems  known  to  himself,  to  his 
master  Valsalva,  and  to  others  among  their  pre- 
decessors, such  as  Bonetus.  Morgagni's  study  of  the 
abnormal  was  based  on  a  sound  knowledge  of  the 
normal.  He  considered  the  commonest  diseases  the 
worthiest  objects  of  investigation,  and  he  was  care- 
ful to  establish  the  relations  between  the  records  of 
his  autopsies  and  the  symptoms  of  the  precedent 
diseases.  His  aim  was  to  explain  disease  by  refer- 


1 82    THE  HISTORY  OF  MEDICINE 

ence  to  its  seat  or  location  rather  than  to  produce  a 
systematic  work  on  morbid  anatomy.  After  his 
time  it  became  more  and  more  the  practice  to  in- 
quire "Where  is  the  disease?"  The  old  humoral 
pathology,  which  had  continued  to  play  a  large  part 
in  the  time  of  Sydenham  and  in  that  of  Boerhaave, 
was  at  last  superseded  by  something  better. 

Morgagni  was  particularly  definite  concerning 
the  location  and  causes  of  apoplexy,  to  which  dis- 
ease his  colleague  Ramazzini  —  one  of  the  earliest 
writers  on  the  pathology  of  the  occupations  —  as 
well  as  Valsalva,  and  Valsalva's  master,  Malpighi, 
had  fallen  victims.  The  cases  recorded  in  Mor- 
gagni's  volumes  show  that  he  had  observed  the 
suffusion  of  blood  on  the  surface  of  the  hemispheres 
(in  some  cases  with  rupture  of  the  arteries  at  the 
basis  of  the  brain),  intra ventricular  haemorrhage 
with  laceration  of  the  choroid  plexus,  and  the  ex- 
travasation of  blood  between  the  pia  and  the  dura 
mater  as  well  as  into  the  substance  of  the  cerebrum. 
Morgagni  noted  that  the  cerebellum  is  less  fre- 
quently the  seat  of  apoplexy  than  is  the  cerebrum. 
He  confirmed  the  observation  of  Valsalva  —  and  of 
some  of  the  leading  authorities  of  antiquity  —  that 
if  the  left  parts  of  the  body  are  paralyzed  the  injury 
is  to  be  found  on  the  right  side  of  the  brain;  and  if 
the  right,  on  the  left.  Morgagni  records,  likewise,  a 
case  in  which  a  fracture  of  the  left  temple  was  fol- 


PATHOLOGY  AND  HISTOLOGY    183 

lowed  by  speechlessness  and  loss  of  control  of  the 
right  hand.  Commenting  on  a  case  of  apoplexy  ac- 
companied by  a  fall,  he  remarks,  "Nor  do  I  attrib- 
ute it  to  the  accidental  fall,  but  the  fall  to  it." 

In  several  of  his  cases  of  apoplexy  Morgagni  men- 
tioned the  excessive  use  of  wine,  but  among  the 
causes  of  the  disease  he  was  inclined  to  lay  special 
emphasis  on  aneurism.  Nothing  is  more  natural,  he 
writes,  than  to  call  to  mind  the  rupture  of  aneurisms 
in  the  abdomen  and  thorax,  and  even  to  imagine 
that  something  similar  to  this  might  sometimes  oc- 
cur within  the  cavity  of  the  cranium ;  especially  as 
those  symptoms  often  precede  the  most  dangerous 
apoplexies  which  would  of  themselves  lead  us  to 
imagine  such  a  circumstance.  For  instance,  two 
aneurisms  preceded  that  apoplexy  which  in  twelve 
hours  carried  off  the  learned  and  worthy  Ramaz- 
zini.  In  fact,  Morgagni  records  the  observation,  in 
another  case,  of  those  miliary  aneurisms,  the  rup- 
ture of  which  is  to-day  recognized  as  the  commonest 
cause  of  cerebral  haemorrhage.  It  might  be  added 
incidentally  that,  according  to  Morgagni,  Valsalva 
and  others  had  known  cases  in  which  the  circulation 
in  a  limb  had  been  adequately  restored  by  collateral 
arteries  after  the  chief  artery  had  become  obliter- 
ated following  an  operation  for  aneurism. 

As  Osier  notes,    Morgagni  recognized   that  the 
infection  with  which  aneurism  is  especially  con- 


1 84     THE  HISTORY  OF  MEDICINE 

nected  is"syphilis.  Of  the  various  manifestations  of 
this  disease  a  great  many  were  known  to  him  that 
were  unknown  to  Hunter  and  other  younger  con- 
temporaries of  the  Italian  pathologist.  After  telling 
of  a  rather  hurried  autopsy  in  which  he  had  found 
aneurism  of  the  aorta  and  a  morbid  condition  of  the 
lungs  Morgagni  surmises  that  a  further  examina- 
tion might  have  revealed  a  diseased  state  of  the 
kidneys.  "For  these  four  parts  —  the  lungs,  the 
aorta,  and  the  kidneys,  with  their  appendages  —  we 
have  found  to  be  injured  in  those  who  have  labored 
considerably,  and  for  a  long  time,  under  this  lues." 
He  observed,  in  other  cases  of  venereal  disease, 
caries  of  the  cranium,  diseased  epiglottis,  as  well  as 
condylomata  and  gummata.  Morgagni  had  not 
himself  seen  the  liver  affected,  though  very  learned 
men  reported  that  this  organ  was  particularly  liable 
to  venereal  infection.  He  believed  indeed  that  the 
lues  venerea  might  vitiate  any  viscus  whatever. 

As  early  as  1743  Morgagni  observed  the  ossifica- 
tion of  the  coronary  arteries.  "As  I  examined,"  he 
writes,  "the  external  surface  of  the  heart,  the  left 
coronary  artery  appeared  to  have  been  changed  into 
a  bony  canal,  from  its  very  origin  to  the  extent  of 
many  fingers'  breadth,  where  it  embraces  the  greater 
part  of  the  base.  And  part  of  that  very  long  branch, 
also,  which  it  sends  down  upon  the  anterior  surface 
of  the  heart,  was  already  become  bony  to  so  great  a 


PATHOLOGY  AND  HISTOLOGY    185 

space  as  could  be  covered  by  three  fingers  placed 
transversely."  The  subject  in  this  case  —  an  old 
man  —  had  been  carried  into  the  hospital  suffering 
from  strangulated  hernia.  Inflammation  of  the 
bowels  developed  soon  after  his  admission,  and  the 
patient  succumbed  almost  immediately.  Morgagni 
was  able  to  learn  very  little  about  his  previous  con- 
dition. The  pulse  was  reported  to  have  been  weak 
and  small,  but  not  intermitting.  Speaking  of 
another  case  recorded  by  others  before  1761,  he 
wished  we  could  know  "what  disorders,  and  what 
kind  of  death,  had  preceded  in  the  man,  in  whom  the 
coronary  veins  of  the  heart  were  found  to  be  bony." 
He  wished  we  could  know,  likewise,  what  particular 
disturbances  had  been  felt  by  those  in  whom  the 
corresponding  arteries  were  bony.  One  writer  had 
supposed  that  this  condition  might  be  extremely 
fatal,  but  that  it  was  so  he  had  been  unable  defi- 
nitely to  affirm.  After  the  death  of  Morgagni,  Ed- 
ward Jenner  conjectured  that  the  heart  disease  from 
which  John  Hunter  suffered  for  twenty  years  was 
caused  by  the  ossification  of  the  coronary  vessels. 
In  reference  to  his  master's  ailment  he  consulted 
Heberden,  who  had  been  the  first,  in  1768,  to  use  the 
expression  angina  pectoris.  Jenner's  conjecture  in 
reference  to  the  condition  of  the  coronary  vessels  in 
the  case  of  Hunter  was  verified  by  the  postmortem 
made  by  Everard  Home. 


1 86     THE  HISTORY  OF  MEDICINE 

Morgagni  has  been  credited  with  the  first  descrip- 
tion of  heart- block  (later  studied  by  Adams,  1827, 
and  Stokes,  1836),  and  with  the  first  recorded  case 
of  disease  of  the  mitral  valve.  He  referred  cyanosis 
in  congenital  heart  disease  to  the  general  congestion 
of  the  venous  system  due  to  obstruction.  He  described 
lobar  pneumonia  with  hepatization.  He  treated  very 
fully  biliary,  renal,  and  cystic  calculi  and  recorded 
cases  of  yellow  atrophy  of  the  liver,  infantile  jaun- 
dice, from  which  all  of  his  fifteen  children  suffered, 
and  tuberculosis  of  the  liver  and  kidneys. 

According  to  Morgagni,  "In  a  woman  who  had 
not  experienced  more  than  dullness  of  hearing,  Val- 
salva  found  the  membrana  tympani  on  both  sides 
either  totally  or  nearly  destroyed  by  ulceration. 
On  one  side  all  the  ossicles  were  thrown  off,  except 
the  base  of  the  stapes;  and  on  the  opposite  side  the 
incus  was  disjoined  from  the  stapes."  Morgagni 
adds  that  he  had  never  heard  of  any  one  who  pre- 
served his  hearing  long  after  the  stapes  had  been 
removed.  He  differed  from  his  predecessors  in  % 
reference  to  the  causal  relationship  between  intra- 
cranial  suppuration  and  discharge  from  the  ear,  and 
supported  his  view  by  citing  a  case  of  abscess  of  the 
brain  which  was  the  "consequence  of  the  suppres- 
sion of  ichor  flowing  out  of  the  ear."  No  symptoms 
of  brain  abscess  had  been  observed  before  the  occur- 
rence of  a  diseased  condition  of  the  ear. 


PATHOLOGY  AND  HISTOLOGY    187 

Hydrophobia,  in  Morgagni's  opinion,  is  caused 
by  a  virus  insinuated  into  the  body.  "  Whoever, 
therefore,  professes  to  have  found  out  the  nature  of 
this  disorder,  must  demonstrate  the  nature  of  this 
poison.  But  I  do  not  even  see  that  the  seat  of  this 
disorder  is  confirmed."  He  mentions,  however,  one 
case  of  hydrophobia  in  which  the  vessels  in  the 
meninges  were  extremely  distended  with  blood. 
Tetanus  was  observed  by  Morgagni  to  result  from 
apparently  trivial  injuries,  such  as  the  bite  of  a  tame 
sparrow,  or  splinters  driven  into  the  hand.  In  one 
of  the  cases  of  tetanus  he  records,  "A  cart-wheel 
passed  over  the  lower  part  of  the  left  heel  of  a  youth 
seventeen  years  of  age;  but  no  other  injury  was 
apparent  except  laceration  of  the  common  integu- 
ments." The  first  seat  of  a  virulent  gonorrhoea,  he 
asserts,  is  in  the  larger  canaliculi  of  the  urethra. 
The  term  "Morgagni's  fossa"  (fossa  navicularis 
urethrse)  and  many  similar  terms  preserve  his 
memory  as  a  careful  anatomist.  "Morgagnian 
cataract"  is  a  phase  of  hypermature  cataract  ob- 
served by  him.  In  reference  to  traumatic  cataract 
Morgagni,  with  his  characteristic  care  in  giving 
credit  to  those  who  have  furthered  the  growth  of 
medical  science,  quotes  Hippocrates  as  saying  that 
the  sight  is  injured  by  wounds  that  are  inflicted  on 
the  eye-brow  or  a  little  above  it. 

Morgagni  was  in  his  eightieth  year  when  he  com- 


1 88     THE  HISTORY  OF  MEDICINE 

pleted  the  "De  Sedibus,"  the  greatest  landmark  in 
the  history  of  pathology.  His  birthplace  was  Forli, 
Romagna.  At  the  age  of  sixteen  he  had  begun  his 
studies  at  the  University  of  Bologna,  where  he  im- 
bibed the  view,  once  voiced  by  Malpighi,  that  sys- 
tems are  ideal  and  mutable,  observation  and  ex- 
perience solid  and  unchangeable.  Before  he  was 
twenty  he  had  graduated  as  doctor  of  medicine  and 
doctor  of  philosophy.  He  succeeded  his  master  Val- 
salva  as  demonstrator  anatomicus.  He  became  known 
as  a  writer  as  early  as  1706.  Six  years  later  he  went 
to  Padua,  where  he  was  appointed  professor  of 
anatomy  in  1715.  He  retained  till  the  time  of  his 
death  the  chair  which  had  been  occupied  by  Vesalius 
and  many  other  distinguished  anatomists.  He  wrote 
voluminously  on  a  wide  range  of  subjects,  and  was 
celebrated  for  general  erudition  and  the  elegance  of 
his  Latin.  He  had  certain  foibles,  the  parsimony 
that  might  be  expected  of  a  father  of  three  sons  and 
twelve  daughters  and  the  vanity  that  sometimes 
marks  the  character  of  great  scholars  and  writers. 
The  five  books  of  the  "De  Sedibus"  contain  the 
record  of  over  six  hundred  dissections  made  by  the 
author  himself  and  the  critical  account  of  a  great 
number  of  autopsies  with  which  his  extended  read- 
ing had  made  him  acquainted.  In  the  words  of 
Virchow,  these  books  contain  all  that  was  known  up 
to  that  time  concerning  changes  produced  by  dis- 


PATHOLOGY  AND  HISTOLOGY    189 

ease  in  the  structure  of  the  human  body.  This 
greatest  pathologist  of  the  nineteenth  century 
acknowledged  the  fundamental  character  of  Mor- 
gagni's  contributions.  They  furnished  a  starting 
point  for  the  progress  of  modern  medicine.  "The 
search  for  the  sedes  morbi  has  advanced  from  the 
organs  to  the  tissues,  and  from  the  tissues  to  the 
cells." 

It  was  Marie  Francois  Xavier  Bichat  who  made 
pathology  dependent  on  a  study  of  the  tissues.  He 
was  born  in  the  village  of  Thoirette,  France,  Novem- 
ber II,  1771,  and  died  at  Paris  July  22,  1802.  His 
father  was  a  doctor  of  medicine  who  had  received 
his  professional  training  at  Montpellier.  The  son, 
Xavier  Bichat,  after  a  very  thorough  general  educa- 
tion at  Nantua  and  Lyons,  began  the  systematic 
study  of  medicine  in  the  latter  city  in  1791.  The 
political  conditions  of  the  time  stimulated  among 
the  doctors  a  special  interest  in  surgery,  and  Bichat 
came  under  the  influence  of  Antoine  Petit,  the  chief 
surgeon  of  the  Hotel  Dieu  of  Lyons.  The  Bichats 
were  not  Revolutionists,  and,  after  the  siege  of 
Lyons  in  1793,  Xavier  left  that  city.  Before  the  end 
of  the  year  he  took  refuge  in  Paris,  and  entered  as  a 
student  the  school  of  the  famous  Desault,  hoping 
later  to  become  an  army-surgeon.  He  mingled 
quietly  with  the  other  students  of  medicine  at  the 
H6tel  Dieu  of  Paris.  The  fall  of  Robespierre  in 


190    THE  HISTORY  OF  MEDICINE 

July,  1794,  brought  to  the  young  man  a  greater 
sense  of  security  and  a  fortunate  incident  gained  for 
him  the  friendship  and  consideration  of  his  master 
Desault.  It  was  customary  in  the  school  for  the 
students  to  take  turns  in  preparing  resumes  of  the 
great  surgeon's  lectures.  One  day  Desault  spoke  at 
length  on  fractures  of  the  clavicle,  giving  a  demon- 
stration of  the  use  of  his  bandage.  When  the  time 
came  for  the  resume,  the  student  who  was  to  have 
given  it  was  not  present  and  Bichat  offered  to  take 
his  place.  Desault's  assistant,  in  whose  presence  the 
report  was  made,  was  deeply  impressed  by  Bichat's 
clearness  of  thought  and  of  expression.  He  told 
Desault  of  the  incident,  and  the  master,  conscious 
of  Bichat's  extraordinary  endowments,  took  the 
young  man  into  his  home  and  treated  him  as  a 
familiar  friend  and  disciple. 

Henceforth  Bichat  seemed  indefatigable.  His  only 
relaxation  was  change  of  work.  He  assisted  Desault 
at  the  hospital,  in  his  operations,  in  his  private 
practice,  his  professional  correspondence,  his  re- 
searches in  surgery.  When,  toward  the  close  of  his 
life,  Desault  gave  an  extended  course  of  lectures  on 
the  diseases  of  the  bones,  his  tireless  assistant  pre- 
pared a  careful  statement  of  the  teachings  of  the 
various  authors  from  the  time  of  Hippocrates  con- 
cerning each  question  taken  under  consideration. 
At  the  same  time  Bichat  continued  to  dissect.  He 


PATHOLOGY  AND  HISTOLOGY     191 

along  with  Corvisart  and  others  founded  the  Soci6t6 
medicale  d'emulation,  before  which  he  read  a  num- 
ber of  papers,  including  one  on  the  synovial  mem- 
brane and  another  dealing  with  the  tissues  in  a  more 
general  way.  After  the  sudden  death  of  Desault,  in 
1795,  Bichat  edited  the  fourth  volume  of  his  master's 
"Journal  de  Chirurgie,"  compiled  two  volumes  of 
extracts  from  the  "Journal,"  and  brought  out  the 
last  volume  of  Desault's  works. 

In  1797  Bichat  undertook  to  lecture  on  anatomy, 
emphasizing  the  mutual  relation  of  structure  and 
function,  and  verifying  his  views  by  the  experi- 
mental study  of  animals.  He  followed  the  course  on 
anatomy  with  one  on  surgery,  but  was  forced  to 
desist  for  a  time  by  a  severe  attack  of  haemoptysis. 
On  his  recovery  he  gave  a  more  extended  course  on 
anatomy,  establishing  a  dissecting  room  and  direct- 
ing the  work  of  about  eighty  students.  In  1800  ap- 
peared two  works  setting  forth  Bichat's  character- 
istic views  concerning  structure  and  function  — 
"Trait6  des  membranes,"  and  "Recherches  physi- 
ologiques  sur  la  vie  et  la  mort."  The  former  became 
the  basis  of  Bichat's  "Anatomie  generate"  (1801), 
which  established  his  claim  as  the  founder  of  his- 
tology; the  latter  distinguished  between  the  vie 
animale  and  the  vie  organique.  These  correspond  to 
the  functions  which  have  to  do  with  the  external 
adjustments  of  the  organism  on  the  one  hand  and  to 


192    THE  HISTORY  OF  MEDICINE 

the  functions  which  preserve  the  automatic  activi- 
ties of  the  individual  on  the  other  hand.  According 
to  Bichat  the  cerebro-spinal  nervous  system  and  the 
ganglionic  nervous  system  are  the  structures  on 
which  the  animal  functions  and  the  organic  func- 
tions respectively  depend.  At  the  same  time  he  dis- 
tinguished the  muscles  of  the  animal  life  from  the 
muscles  of  the  organic  life. 

Before  the  appearance  of  Bichat's  "  Anatomic 
gen6rale"  the  study  of  anatomy  had  been  largely  a 
study  of  the  organs.  These,  according  to  Bichat, 
admit  of  histological  analysis,  disentanglement  of 
their  component  parts.  The  organs,  as  he  says,  are 
made  up  of  tissues  which  are  of  very  different  kinds 
and  which  really  constitute  its  elements.  Chemistry, 
he  proceeds,  has  its  simple  bodies,  which  by  various 
combinations,  of  which  they  are  capable,  form  com- 
pound bodies;  likewise  anatomy  has  its  simple  tis- 
sues, which,  by  their  fourfold  or  sixfold  combina- 
tion, form  the  organs.  Again,  he  compares  the  study 
of  general  anatomy  to  that  to  which  an  architect 
applies  himself  who,  before  constructing  a  house, 
tries  to  learn  in  detail  the  nature  of  the  various 
materials  he  has  to  employ.  The  study  of  the  gen- 
eral anatomist,  as  already  implied,  is  analogous  to 
that  of  the  chemist  who,  before  knowing  the  com- 
pound bodies,  examines  in  isolation  the  elements 
which  compose  them,  who  before  investigating,  for 


PATHOLOGY  AND  HISTOLOGY 

example,  the  properties  of  the  neutral  salts,  wishes 
to  know  their  radicals.  The  study  of  general  anat- 
omy, or  histology,  is  in  a  sense,  like  chemistry,  an 
abstract  study:  for  no  tissue  exists  in  isolation;  all 
tissues  are  combined  in  a  more  or  less  considerable 
number. 

What  are  the  organic  elements,  which  Bichat,  in 
his  search  for  a  morphological  unit  comparable  with 
the  oxygen,  nitrogen,  carbon,  and  hydrogen  known 
to  the  chemists  of  his  time,  discovered  to  be  the 
components  of  the  organs  of  the  body?  He  mentions 
twenty-one:  cellular,  nervous  of  animal  life,  nervous 
of  organic  life,  arterial,  venous,  tissue  of  exhalants, 
that  of  absorbents  and  their  glands,  osseous  tissue, 
medullary,  cartilaginous,  fibrous,  fibro-cartilagi- 
nous,  muscular  of  animal  life,  muscular  of  organic 
life,  mucous,  serous,  synovial,  glandular,  dermal, 
epidermal,  and  pilous.  It  is  of  interest  to  find  that 
the  father  of  modern  histology  in  the  task  of  differ- 
entiating tissue  from  tissue  considered  the  micro- 
scope of  his  time  a  hindrance  rather  than  a  help. 
He  chose,  instead,  to  submit  them  to  the  action  of 
heat,  air,  water,  the  acids,  the  alkalies,  and  salts. 
He  observed  them  under  putrefaction  and  various 
other  conditions,  drying,  boiling,  and  macerating 
them.  "The  relation,"  says  Bichat,  "of  properties 
as  causes  with  phenomena  as  effects  is  an  axiom  in 
physics,  chemistry,  and  astronomy,  almost  too 


194    THE  HISTORY  OF  MEDICINE 

hackneyed  to  repeat  to-day.  If  my  work  establishes 
an  analogous  axiom  in  physiological  science,  it  will 
have  fulfilled  its  aim."  According  to  him  one  must 
first  discover  the  minute  anatomy  of  the  tissues,  and 
the  vital  functions  of  the  physiological  elements. 
Pathological  phenomena  involve  an  alteration  of 
these  elements;  therapeutics  is  concerned  with 
restoration  of  the  normal  functions  of  the  elements. 
At  the  same  time  Bichat  regarded  general  anat- 
omy, or  the  study  of  the  tissues,  as  an  essential  in- 
troduction to  descriptive  anatomy  as  well  as  to 
pathology  and  therapeutics.  The  twenty-one  tissues 
were  the  subject  of  his  "Anatomic  generate";  their 
various  combinations  were  the  subject  of  his  "Anat- 
omic descriptive."  According  to  Bichat,  descriptive 
anatomy  examines  the  organs  just  as  nature  pre- 
sents them  to  us.  It  investigates  first  their  external 
form,  position,  size,  direction,  etc.  Then,  pene- 
trating more  deeply  into  their  structure,  it  examines 
the  number  of  systems  —  nervous,  muscular,  serous, 
mucous,  etc. —  which  contribute  to  the  formation  of 
each,  and  the  particular  modifications  they  may 
undergo  in  each  case;  moreover,  it  must  not  be  in- 
different to  the  relations  of  the  structure  to  the  func- 
tions. The  stomach,  for  example,  must  be  studied 
as  an  assemblage  of  tissues  —  mucous  inside,  serous 
outside,  organic  muscular  in  the  middle.  He  who 
attempts  to  study  the  organs  by  means  of  the  scalpel 


PATHOLOGY  AND  HISTOLOGY    195 

is  like  the  architect  who  examines  each  room  of  a 
building,  or  like  the  chemist  who  investigates  the 
reactions  of  the  compounds  without  regard  to  the 
elements  of  which  each  is  made  up.  Bichat  pub- 
lished two  volumes  of  the  "Anatomic  descriptive"; 
at  the  time  of  his  death  he  had  almost  completed  a 
third  volume  and  had  prepared  material  for  a  fourth. 
Two  of  his  friends  brought  the  work  to  a  conclusion 
in  a  fifth  volume.  Bichat  and  those  with  whom  he 
was  associated  carried  into  the  field  of  science  the 
ardor  and  enthusiasm  of  the  Napoleonic  age. 

He  pursued  the  study  of  morbid  anatomy,  espe- 
cially after  his  appointment  as  physician  at  the 
Hotel  Dieu  in  1800,  with  an  almost  incredible  vigor 
and  heroism.  At  the  same  time  he  had  the  oppor- 
tunity of  seeing  all  the  remarkable  cases  of  illness  in 
that  metropolitan  hospital,  where  his  amiable  and 
magnanimous  disposition  almost  disarmed  envy  it- 
self. He  was  natural  and  spontaneous  without  being 
inconsiderate.  He  was  prepossessing,  frank  and 
candid,  incapable  of  anger  or  impatience,  quick  to 
welcome  the  views  or  recognize  the  merit  of  others, 
generous  and  tolerant,  approachable  even  when 
absorbed  in  work.  He  held,  as  we  have  seen,  that 
disease  involves  an  alteration  of  the  tissues  of  which 
the  organism  is  composed.  "  Let  us  take  for  example 
the  lungs,"  he  is  reported  to  have  said  in  his  last 
course  of  lectures.  "These  organs  are  composed  of 


196    THE  HISTORY  OF  MEDICINE 

the  pleura,  of  the  parenchymatous  structure  of  the 
lungs,  and  of  the  internal  membrane.  In  pleurisy, 
the  pleura  only  is  inflamed,  the  pulmonary  tissue 
and  the  mucous  membrane  remain  untouched.  In 
pneumonia,  it  is,  on  the  contrary,  the  parenchymat- 
ous structure  of  the  lungs  that  is  affected,  while  its 
two  membranes  remain  healthy.  In  the  same  man- 
ner catarrhal  cough  is  exclusively  confined  to  the 
mucous  membrane,  while  the  pulmonary  tissue  and 
the  serous  membrane  are  sound  and  healthy.  We 
may  reason  in  the  same  manner  in  relation  to  all  the 
other  organs."  Thus  Bichat,  consciously  building 
on  the  work  of  Morgagni,  whom  he  considered  the 
founder  of  pathological  science,  sought  to  advance 
from  a  pathology  of  the  organs  to  a  pathology  of  the 
tissues  composing  the  organs.  "It  is  to  him,"  says 
Buisson,  "that  we  are  indebted  for  definite  ideas 
concerning  diseases  of  the  peritoneum,  diseases 
which  had  been  usually  confused  with  those  of  the 
organs  covered  by  that  membrane.  He  proved  that 
each  tissue  has  a  special  sort  of  malady,  as  well  as  a 
special  character  of  vitality,  and  that  even  in  the 
intestines,  the  morbid  state  of  one  tissue  may  be  as- 
sociated with  the  healthy  state  of  the  neighboring 
tissues.  Some  authors  had  apprehended  this  truth; 
Walter  had  indeed  indicated  exactly  the  nature  of 
peritonitis;  but,  while  all  had  observed  particular 
facts,  none  had  attached  these  ideas  to  a  particular 
point  of  view." 


PATHOLOGY  AND  HISTOLOGY    197 

Bichat's  study  of  therapeutics  was,  like  his  study 
of  pathology  and  descriptive  anatomy,  based  on  his 
early  study  of  the  structure  and  functions  of  the 
tissues.  In  the  presence  and  with  the  cooperation  of 
more  than  forty  students  he  examined  the  action  of 
drugs  on  the  various  systems  into  which  he  had 
analyzed  the  organism.  He  was  still  engaged  in  this 
investigation  when  death  overtook  him.  He  had 
worn  himself  out  with  almost  superhuman  exertions. 
Within  a  few  months  he  had  opened  more  than  six 
hundred  bodies  at  the  H6tel  Dieu  and  elsewhere. 
The  fatigue  resulting  from  his  ceaseless  activities 
had  weakened  his  resistance  to  the  inroads  of  dis- 
ease. On  July  8,  1802,  he  examined  some  macerated 
tissues  which  were  in  such  an  advanced  state  of 
putrefaction  that  the  students  were  driven  out  of 
the  laboratory  by  the  odor.  When  Bichat  finally 
withdrew  from  his  task  he  fell  on  the  staircase  in  the 
hospital,  and,  hitting  his  head,  was  rendered  for  a 
time  unconscious.  On  the  following  day  he  tried  to 
resume  his  professional  activities,  but  was  seized 
by  a  violent  headache.  He  succumbed  to  typhoid 
fever  July  22. 

Corvisart,  Napoleon's  favorite  physician,  wrote 
to  the  First  Consul:  "Bichat  has  just  died  on  a 
battle-field  which  has  claimed  more  than  one  victim ; 
no  person,  in  so  short  a  time,  has  done  so  much  and 
so  well."  Napoleon  shortly  after  gave  directions 


198    THE  HISTORY  OF  MEDICINE 

that  a  tablet  be  placed  in  the  H6tel  Dieu  commemo- 
rating the  friendship  and  labors  of  Desault  and 
Bichat.  "Bichat,"  wrote  Bonaparte,  "would  have 
greatly  extended  the  domain  of  this  science,  so  im- 
portant and  so  dear  to  humanity,  if  pitiless  death 
had  not  struck  him  down  at  thirty  years." 

Buckle  says  that,  "  If  we  compare  the  shortness  of 
his  life  with  the  reach  and  depth  of  his  views,"  he 
"must  be  pronounced  the  most  profound  thinker 
and  consummate  observer  by  whom  the  animal 
frame  has  yet  been  studied."  He  adds:  "We  may 
except  Aristotle,  but  between  Aristotle  and  Bichat  I 
find  no  middle  man."  We  shall  be  safer,  however,  in 
accepting  the  soberer  judgment  of  the  physiologist 
Carpenter,  who  says:  "Altogether  Bichat  left  an 
impress  on  the  science  of  life,  the  depth  of  which  can 
scarcely  be  overrated ;  and  this  not  so  much  by  the 
facts  which  he  collected  and  generalized,  as  by  the 
method  of  inquiry  which  he  developed,  and  by  the 
systematic  form  which  he  gave  to  the  study  of  gen- 
eral anatomy  in  relation  both  to  physiology  and 
pathology." 

REFERENCES 

Bichat,  M.  F.  X.:  (i)  Traite  des  Membranes.  1800. 

(2)  Recherches  physiologiques  sur  la  vie  et  la  mort.  1800. 

(3)  Anatomie  generate.  2  vols.  1801. 

(4)  Anatomie  descriptive.   5  vols. 

Eycleshymer,  A.  C.:  "Xavier  Bichat,"  Interstate  Med.  Journal, 
St.  Louis,  1908,  vol.  xv. 


PATHOLOGY  AND  HISTOLOGY    199 

Morgagni,  G.  B.:  (i)  The  Seats  and  Causes  of  Diseases  (abridged 

by  William  Cooke).   Boston,  1824. 
(2)  The    Seats   and    Causes   of  Diseases    (translated  by 

Benjamin  Alexander).    3  vols.,  London,  1769. 
Virchow,    Rudolf:    "Morgagni    and    'Anatomical  Thought,' " 

British  Medical  Journal,  April  7,  1894.    Eleventh  Intern. 

Med.  Congress,  Rome. 
Walsh,  J.  J.:    Makers  of  Modern  Medicine.    New  York,  1907, 

PP-  29-51. 


CHAPTER  X 
LOCAL  DIAGNOSIS:  AUENBRUGGER,  LAENNEC 

IN  the  same  year  as  Morgagni's  "De  Sedibus  et 
Causis  Morborum,"  appeared  the  "New  Invention 
for  Discovering  Obscure  Thoracic  Diseases  by  Per- 
cussion of  the  Chest."  This  "Inventum  Novum" 
was  the  work  of  Leopold  Auenbrugger  (1722-1809), 
the  son  of  an  innkeeper  of  Graz,  Austria.  He  was 
educated  at  the  University  of  Vienna,  and  in  1751 
received  an  appointment  in  the  Spanish  Military 
Hospital  of  the  Austrian  capital.  It  was  the  age  of 
Maria  Theresa.  In  spite  of  the  struggles  of  the  Em- 
pire with  Frederick  the  Great  of  Prussia  and  other 
enemies,  Vienna  continued  to  be  one  of  the  chief 
centers  of  European  culture.  At  the  time  of  the  ap- 
pearance of  the  "Inventum  Novum,"  the  child 
prodigy  Mozart  was  about  to  make  his  d£but  at  the 
Austrian  court,  Gluck  was  the  Kapellmeister  of  the 
Empress,  while  Haydn  held  a  similar  position  under 
the  princely  patronage  of  the  Hungarian  house  of 
Eszterhazy.  Into  the  culture  life  of  Vienna  at  this 
time  Auenbrugger  was  fitted  by  his  talents  and 
temperament  to  enter.  He  was  popular  at  the  im- 
perial court;  extremely  fond  of  music,  he  composed 
the  libretto  of  an  opera,  "The  Chimney  Sweep" 


LOCAL  DIAGNOSIS  201 

("Der  Rauchfangkehrer"),  to  please  the  Empress; 
and  later  received  from  her  son,  Emperor  Joseph  II, 
the  title  Edler  von  Auenbrug  on  account  of  his 
geniality  and  other  fine  social  qualities,  and  not  on 
account  of  his  contribution  to  the  advance  of  medi- 
cal science. 

In  fact,  the  "Inventum  Novum"  brought  only  an 
inadequate  response  from  Auenbrugger's  contempo- 
raries of  the  Old  Vienna  School.  His  teacher,  the 
autocratic  Gerard  van  Swieten,  ignored  it,  as  did 
also  Anton  de  Haen.  These  two  leaders  and  volu- 
minous writers  had  studied  at  Leyden  under  their 
fellow  countryman  Boerhaave,  whose  influence  they 
perpetuated.  Maximilian  Stoll  (1742-86),  however, 
who  succeeded  de  Haen  as  clinical  teacher  at 
Vienna,  recognized  the  value  of  Auenbrugger's 
method  both  in  the  diagnosis  and  treatment  of 
pleurisy  and  empyema.  And  of  course  long  after  the 
prophet's  death  he  found  honor  in  his  own  country; 
for  in  1839  Skoda,  the  leading  clinician  of  the  New 
Vienna  School,  wrote  a  treatise  on  percussion  and 
auscultation,  and  "diagnosis  confirmed  by  post- 
mortem" became  the  watchword  in  the  medical 
circles  of  the  Austrian  capital. 

In  the  preface  to  the  "  Inventum  Novum"  Auen- 
brugger  says:  "  I  here  present  the  reader  with  a  new 
sign  which  I  have  discovered  for  detecting  diseases 
of  the  chest.  This  consists  m  the  percussion  of  the 


202    THE  HISTORY  OF  MEDICINE 

human  thorax,  whereby,  according  to  the  character 
of  the  particular  sounds  thence  elicited,  an  opinion 
is  formed  of  the  internal  state  of  that  cavity."  The 
brief  treatise  was  the  outcome  of  seven  years'  ob- 
servation, experiment,  and  reflection.  "What  I  have 
written  I  have  proved  again  and  again,  by  the  testi- 
mony of  my  own  senses,  and  amid  laborious  and 
tedious  exertions."  But  in  spite  of  his  confidence  in 
the  results  he  had  achieved,  he  was  far  from  believ- 
ing that  he  had  exhausted  the  possibilities  of  his 
method,  and  he  hoped  that  further  observation  and 
experience  would  lead  to  the  discovery  of  other 
truths,  in  these  or  other  diseases,  of  like  value  in  the 
diagnosis,  prognosis,  and  cure  of  thoracic  affections. 
The  sound  obtained  on  the  percussion  of  certain 
parts  of  the  healthy  chest  resembles  the  stifled  sound 
of  a  drum  covered  with  a  thick  woollen  cloth  or 
other  envelope.  The  most  sonorous  region  is  from 
the  clavicle  to  the  fourth  rib  anteriorly.  "The 
thorax  ought  to  be  struck,  slowly  and  gently,  with 
the  points  of  the  fingers,  brought  close  together  and 
at  the  same  time  extended."  The  patient  is  told  at 
first  to  breathe  naturally;  later  he  is  directed  to  hold 
his  breath  after  a  full  inspiration.  During  the  exami- 
nation the  patient  must  assume  such  an  attitude  as 
will  render  tense  that  part  of  the  chest  wall  which 
at  the  moment  is  being  subjected  to  percussion;  for 
thus  a  clearer  sound  is  obtained. 


LOCAL  DIAGNOSIS  203 

Auenbrugger  believed  that  thoracic  diseases  of 
the  worst  description  might  exist  without  any  symp- 
toms save  those  revealed  by  his  method  of  percus- 
sion. If  a  naturally  sonorous  part  of  the  chest  is,  on 
percussion,  devoid  of  the  usual  resonance  —  yielding 
only  the  sound  of  a  fleshy  limb  when  struck  —  or  if  it 
gives  out  a  sound  duller  than  usual,  disease  exists  in 
that  part.  He  considered  that  the  deviations  from 
the  natural  sound  are  owing  to  the  diminution  of  the 
amount  of  air  normally  contained  in  the  lungs,  a 
diminution  which  might  arise  from  the  occurrence  of 
solids  or  liquids.  An  analogous  sound  may  be  ob- 
tained by  striking  a  cask  partly  filled  with  water. 
The  preternatural  sound  always  accompanies  a 
copious  effusion  of  fluid  in  the  thoracic  cavity. 
Moreover,  the  "effect  of  effused  liquids  in  producing 
the  morbid  sound  is  at  once  proved  by  the  injection 
of  water  into  the  thorax  of  a  dead  body;  in  which 
case  it  will  be  found  that  the  sound  elicited  by  per- 
cussion will  be  obscure  over  the  portion  of  the  cavity 
occupied  by  the  injected  liquid."  In  addition  to  the 
methods  of  investigation  of  which  Auenbrugger 
gives  here  an  indication,  there  is  abundant  evidence 
that  he  made  it  a  practice,  where  it  was  feasible,  to 
confirm  his  diagnosis  by  post-mortem  examination. 

The  appearances  on  dissection  in  cases  where  per- 
cussion had  revealed  an  abnormal  condition  fall  into 
two  classes  —  those  that  involve  primarily  the 


204    THE  HISTORY  OF  MEDICINE 

respiratory  functions,  and  those  found  in  the  heart 
and  pericardium.  Under  the  first  class  Auenbrugger 
noted  the  degeneration  of  the  lung  substance,  the 
post- mortem  organ  being  so  engorged  with  blood  as 
to  resemble  liver  in  every  respect,  both  as  to  color 
and  consistency.  Among  the  symptoms  exhibited 
by  patients  suffering  from  such  a  degeneration  of 
the  lung  substance  he  mentions  the  diminution  or 
entire  absence  of  the  natural  sound  over  the  affected 
part,  and  the  relative  immobility,  during  inspiration, 
of  the  chest  on  the  affected  side.  Auenbrugger  de- 
scribed vomicae  resulting  from  the  degeneration  of 
the  lung  substance.  They  are  encysted  or  contained 
in  a  sort  of  capsule;  some  of  them  are  purulent, 
some  are  not;  some  are  closed,  others  communicate 
with  the  bronchi.  If,  in  the  case  of  a  patient  suffer- 
ing from  a  purulent  vomica  which  is  discharging  into 
the  trachea,  while  the  patient  is  coughing  and  spit- 
ting the  physician  places  his  hand  over  the  site  of 
the  vomica,  the  noise  of  fluid  within  the  chest  will  be 
distinctly  manifest.  When  a  vomica  discharges  its 
contents  into  the  cavity  of  the  pleura  and  upon  the 
diaphragm,  empyema  is  produced.  "If  percussion 
is  now  applied,  it  will  be  found  that  the  natural 
sound,  which  had  been  nearly  lost  on  the  site  of  the 
vomica,  has  in  some  degree  been  restored  in  that 
place;  while  it  is  more  or  less  destroyed  —  according 
to  the  quantity  of  pus  effused  —  over  the  posterior 


LOCAL  DIAGNOSIS  205 

and  inferior  parts  of  the  chest."  By  dissection  Auen- 
brugger  also  verified  his  diagnosis  of  unilateral  and 
bilateral  hydrothorax.  Among  the  symptoms  re- 
vealed by  percussion  he  mentions  a  murmuring 
sound  about  the  hypochondriac  region.  Moreover, 
in  unilateral  hydrothorax,  "the  affected  side,  if  com- 
pletely filled  with  water,  is  enfeebled  and  appears 
less  movable  during  inspiration.  In  this  case,  also, 
the  affected  side  yields  nowhere  the  natural  sound 
on  percussion.  If  the  chest  is  only  half  filled,  a 
louder  sound  will  be  obtained  over  the  parts  to  which 
the  fluid  does  not  extend,  and  the  resonance  will  be 
found  to  vary  according  to  the  position  of  the  pa- 
tient and  the  consequent  level  to  which  the  liquid 
attains."  Auenbrugger  mentions  hsemothorax  with 
and  without  an  accompanying  lesion  of  the  lungs. 
He  had  never  seen  chylothorax,  though  he  believed 
the  disease  existed  in  spite  of  the  fact  that  the 
thoracic  duct  runs  outside  the  pleura. 

As  regards  diseases  of  the  heart  and  pericardium 
Auenbrugger's  researches  contributed  to  our  knowl- 
edge of  the  symptoms  and  the  morbid  anatomy.  In 
health  the  whole  sternum  yields  on  percussion  as 
distinct  a  sound  as  the  sides  of  the  chest,  except  in 
the  cardiac  region,  where  it  is  somewhat  duller; 
similarly  on  the  left  side  of  the  chest,  over  the  space 
occupied  by  the  heart  the  sound  loses  part  of  its 
usual  clearness.  In  hydropericardium  the  sound  is 


206     THE  HISTORY  OF  MEDICINE 

completely  deadened  as  if  the  percussion  were  ap- 
plied to  a  healthy  limb.  Post-mortem  discloses  —  in 
cases  of  dropsy  of  the  pericardium  —  either  a  serous 
effusion  or  a  purulent  effusion,  which  commonly  re- 
sembles turbid  whey.  The  same  signs  are  furnished 
by  percussion  in  either  case.  "In  the  first  variety 
the  heart  is  rough,  and,  as  it  were,  shaggy,  with  a 
coating  of  the  purulent  matter."  In  the  case  of 
copious  extravasation  of  blood  into  the  pericardium 
percussion  elicits  none  of  the  natural  sounds  over  the 
space  occupied  by  the  extravasated  blood.  Similar 
results  are  yielded  by  percussion  in  cases  of  dilata- 
tion of  the  heart. 

In  spite  of  such  recognition  as  the  "Inventum 
Novum"  early  gained  in  Vienna  and  other  centers 
of  German  medicine  and  its  translation  into  French 
within  a  decade  of  its  appearance,  it  remained  for  the 
great  French  clinician  Corvisart  (1755-1821)  and 
his  pupils  to  make  Auenbrugger's  influence  at  all 
general.  Corvisart  was  an  enthusiastic  admirer  of 
the  teachings  of  the  Vienna  School,  and  was  particu- 
larly familiar  with  the  works  of  Stoll.  In  1808,  a 
year  before  the  death  of  Auenbrugger,  he  translated 
the  "Inventum  Novum"  into  French  and  wrote 
commentaries  upon  it.  In  1806,  under  the  direct 
encouragement  of  the  Emperor  Napoleon,  he  had 
published  his  own  masterpiece,  "Essai  sur  les  mala- 
dies et  les  lesions  du  coeur  et  des  gros  vaisseaux." 


LOCAL  DIAGNOSIS  207 

In  this  work  Corvisart  directs  attention  in  the  first 
place  to  diseases  of  the  pericardium,  notes  the  com- 
parative dullness  of  the  sound  resulting  from  per- 
cussion of  the  cardiac  region  in  hydropericardium. 
and,  later,  studies  the  symptoms  of  dilatation,  as 
well  as  of  aneurism  of  the  thoracic  aorta.  His  diag- 
noses seemed  to  his  pupils  at  times  the  result  of 
intuition,  but  he  was  indeed  a  keen  observer  with  a 
delicate  sense  of  touch,  and  an  acute  sense  of  hearing 
that  led  him  to  anticipate  the  discovery  of  ausculta- 
tion. He  also  urged  physicians  not  to  neglect  post- 
mortem examination,  an  injunction  carefully  heeded 
by  his  pupils  Bayle  and  Laennec. 

"Our  real  knowledge,"  writes  Osier  of  tuberculo- 
sis, "is  a  nineteenth  century  contribution,  beginning 
with  the  work  of  Bayle  on  the  structure  of  the  tuber- 
cle and  on  its  identity  in  the  widely  distributed 
lesions."  In  his  early  work,  "  Phthisic  pulmonaire," 
Bayle  spoke,  like  his  predecessors,  of  types  of 
phthisis  other  than  the  tuberculous,  but  in  his  later 
work,  "Remarques  sur  les  tubercles,"  he  recognized 
the  specific  character  of  the  disease.  He  defined 
tubercles  as  little  cysts  containing  organized  solid 
matter,  capable  of  softening  and  breaking  down. 
He  had  found  them  post-mortem  in  the  lungs, 
mesentery,  liver,  kidneys,  prostate,  and  other  or- 
gans, but  he  had  not  observed  them  in  the  brain. 
The  fact  that  they  might  occur  so  widely  distributed 


208    THE  HISTORY  OF  MEDICINE7 

in  the  one  subject  seemed  to  indicate  that  all  tu- 
bercles are  identical  in  nature.  He  even  used  the 
expression  "tuberculous  diathesis"  to  designate  a 
constitutional  tendency  to  tuberculosis.  In  the 
diagnosis  of  diseases  of  the  chest  Bayle  resorted  to 
immediate  auscultation.  The  employment  of  this 
method  by  Bayle  led  to  its  adoption  by  his  fellow 
student  Laennec  and  thus  to  the  discovery  of  a 
much  better  method. 

Rene  Theophile  Hyacinthe  Laennec  was  born  at 
Quimper,  Finistere  (the  French  Land's  End),  Feb- 
ruary 17,  1781.  One  of  his  relatives,  under  whose 
direction  he  began  his  professional  education,  had 
been  a  pupil  of  John  Hunter's.  Rene  Laennec  studied 
medicine  as  early  as  1795  at  the  H6tel  Dieu  at 
Nantes,  accompanied  a  military  expedition  against 
an  insurrection  in  the  west  of  France  in  1800,  had  a 
little  experience  in  military  hospitals,  and  before 
the  end  of  1800  went  to  Paris  for  further  training  in 
medicine.  There  he  attended  the  popular  clinics  of 
Corvisart  at  the  Unit6  (Charite),  met  Bayle,  and 
heard  Bichat's  last  course.  His  medical  education 
was  very  thorough.  During  three  years  as  student 
at  La  Charit6  he  wrote  up  four  hundred  cases  that 
came  under  his  observation.  He  discovered  the  del- 
toid bursa  and  the  fibrous  capsule  of  the  liver;  and 
he  became  a  recognized  authority  in  morbid  anatomy. 
His  culture  was  not  confined  to  narrow  professional 


LOCAL  DIAGNOSIS  209 

lines ;  he  was  a  linguist  and  something  of  a  poet ;  he 
was  versed  in  the  writings  of  Hippocrates  and  the 
other  great  physicians  of  the  past,  and  he  held  that 
discoveries  in  medical  science  are  made  only  by  those 
who  know  its  history. 

Among  the  many  influences  that  led  to  Laennec's 
great  invention  was  the  work  of  Chladni  in  acoustics 
which  had  been  stimulated  in  the  first  place  by  an 
intense  interest  in  music.  Chladni  had  given  an  ac- 
count of  his  researches  in  the  presence  of  some  of  the 
leading  scientists  of  Paris;  and  in  1809  had  pub- 
lished a  French  edition  of  his  work  under  the  title 
"Trait6  d'acoustique."  The  Emperor  had  drawn 
general  attention  to  the  subject  by  the  terse  remark: 
"Chladni  makes  tones  visible."  One  day  about  the 
middle  of  October,  1816,  Laennec  saw  some  boys  at 
play  in  a  court  of  the  Louvre,  who  by  listening  at 
the  end  of  a  beam  were  able  to  hear  the  sound  of  the 
scratching  of  a  pin  transmitted  from  the  other  end. 
On  the  following  day  there  occurred  an  experience 
which  we  shall  relate  in  Laennec's  own  words. 

" I  was  consulted  in  1816,"  he  writes,  "in  the  case 
of  a  young  person  who  showed  symptoms  of  heart 
disease  and  in  whom  palpation  and  percussion  gave 
poor  results  on  account  of  her  embonpoint.  The  age 
and  sex  of  the  patient  forbidding  the  sort  of  exami- 
nation of  which  I  have  just  spoken,  immediate 
auscultation,  I  happened  to  recall  a  familiar  fact  in 


2io    THE  HISTORY  OF  MEDICINE 

acoustics,  namely,  that  if  one  places  his  ear  at  one 
end  of  a  piece  of  timber  he  can  hear  very  distinctly 
the  scratch  of  a  pin  at  the  other  end.  It  occurred  to 
me  that  I  might  take  advantage,  in  the  case  with 
which  I  had  to  deal,  of  this  physical  property.  I 
took  a  paper  notebook,  rolled  it  up  tightly,  applied 
one  end  to  the  precardiac  region  and  listened  at  the 
other.  I  was  as  greatly  surprised  as  I  was  pleased  to 
hear  the  heart-beats  much  more  clearly  and  dis- 
tinctly than  I  had  ever  been  able  to  hear  them 
through  the  immediate  application  of  the  ear.  From 
that  time  I  took  it  for  granted  that  this  means  might 
become  a  method  useful  and  applicable  not  only  in 
the  study  of  heart-beats,  but  in  the  study  of  all 
movements  which  may  produce  a  sound  in  the 
thorax,  and,  consequently,  in  the  examination  of  the 
respiration,  of  the  voice,  of  the  r&le,  and  perhaps 
even  of  an  effusion  in  the  pleura  or  pericardium." 
Under  this  conviction  Laennec  began  at  once  a 
series  of  observations  at  the  Necker  Hospital  (to 
which  he  had  just  been  appointed  visiting  physician) 
from  which  he  was  able  to  deduce  a  set  of  new  signs 
of  diseases  of  the  chest,  which  he  considered  certain, 
simple,  striking,  and  calculated,  perhaps,  to  render 
the  diagnosis  of  diseases  of  the  lungs,  pleura,  and 
heart  as  definite  as  the  indications  furnished  to  the 
surgeon  in  the  case  of  a  stone  in  the  bladder  or  of  a 
fractured  limb.  The  first  instrument  of  which  he 


LOCAL  DIAGNOSIS  211 

made  use  was  a  cylinder  of  paper,  tightly  rolled,  and 
kept  in  shape  by  means  of  paste.  Later  he  tried 
various  other  materials.  Following  a  series  of  ex- 
periments, he  employed  in  his  examinations  of  the 
chest  sounds  "a  cylinder  of  wood,  an  inch  and  a 
half  in  diameter,  and  a  foot  long,  perforated  longi- 
tudinally by  a  bore  three  lines  wide,  and  hollowed 
out  into  a  funnel-shape,  to  the  depth  of  an  inch  and 
a  half,  at  one  of  the  extremities."  To  this  instrument 
he  gave  the  name  "stethoscope"  (OTTJ^OS,  chest, 
and  o-Koirelv,  explore). 

Laennec  reported  some  of  his  results  to  the  Acad6- 
mie  des  Science  in  1818,  and  in  1819  published  the 
first  edition  of  his  work  "De  1' Auscultation  Mediate." 
In  1820  he  retired  to  Kerlouarnec,  where  he  spent 
two  years  resting  and  recuperating.  In  1822  he  re- 
turned to  Paris,  and  received  appointment  as  pro- 
fessor of  medicine  at  the  College  de  France.  In  the 
following  year  he  was  given  the  chair  of  clinical 
medicine  at  La  Charit6.  In  1826  appeared  the  sec- 
ond edition  of  his  great  work. 

Like  Auenbrugger,  of  whose  method  of  percussion 
he  had  made  considerable  use,  Laennec  sought  first 
of  all  to  establish  the  sounds  heard  on  the  examina- 
tion of  a  normal  subject.  "On  applying  the  cylin- 
der," he  writes,  "...  to  the  breast  of  a  healthy 
person,  we  hear,  during  inspiration  and  expiration, 
a  slight  but  extremely  distinct  murmur,  answering 


212    THE  HISTORY  OF  MEDICINE 

to  the  entrance  of  air  into,  and  its  expulsion  from, 
the  air  cells  of  the  lungs." 

Shortly  after  beginning  his  observations  by  means 
of  the  newly  discovered  method,  Laennec,  in  the 
case  of  a  woman  suffering  with  a  slight  bilious  fever 
and  a  recent  cough,  applied  the  cylinder  below  the 
middle  of  the  right  clavicle  while  she  was  speaking. 
Her  voice  seemed  to  come  directly  from  the  chest, 
and  to  reach  the  ear  through  the  central  canal  of  the 
instrument.  This  peculiar  phenomenon  was  con- 
fined, he  proceeds,  to  a  space  about  an  inch  square. 
Ignorant  of  the  cause  of  this  singularity,  he  exam- 
ined the  greater  number  of  the  patients  in  the  hos- 
pital, and  found  the  same  phenomenon  in  about 
twenty  of  them.  He  began  to  suspect  that  it  might 
be  caused  by  tuberculous  cavities  in  the  lungs.  The 
subsequent  death  of  the  majority  of  the  patients 
who  had  exhibited  this  peculiarity  gave  him  the  op- 
portunity to  verify  his  conjecture.  In  all  cases  post- 
mortem examination  revealed  larger  or  smaller  cav- 
ities, which  communicated  with  the  bronchial  tubes 
and  which  were  the  result  of  the  breaking  down  of  tu- 
bercles. "I  found  the  peculiar  phenomenon  (which 
I  have  termed  Pectoriloquy)  to  be  perceptible  accord- 
ing to  the  density  of  the  walls  of  the  cavity  and  its 
proximity  to  the  surface  of  the  lungs." 

Laennec,  though  inclined  to  admit,  like  Auen- 
brugger,  the  possibility  of  a  phthisis  nervosa,  taught 


LOCAL  DIAGNOSIS  213 

that  pulmonary  consumption  is  caused  by  the  de- 
velopment in  the  lungs  of  tubercles  which  may  ap- 
pear as  isolated  bodies  or  as  a  tuberculous  infiltra- 
tion. Under  the  former  come  miliary  tubercles, 
crude  tubercles,  encysted  tubercles,  and  tuberculous 
granules.  Under  tuberculous  infiltration  he  recog- 
nized the  gray  and  the  yellow.  Laennec  observed 
tubercles  in  the  peritoneum,  testicles,  uterus,  cervi- 
cal and  mesenteric  glands,  heart,  spleen,  brain, 
bones  of  skull,  ribs,  vertebrae  and  their  ligaments. 
For  him  scrofula  was  tuberculosis  of  the  glands;  he 
insisted  on  the  frequency  of  tuberculous  pleurisy ;  in 
fact,  he  supported  the  doctrine  of  Bayle  in  reference 
to  the  specific  character  of  tuberculosis.  In  pulmon- 
ary tuberculosis  tubercles  should  be  especially  sus- 
pected at  the  apex  of  the  lungs,  and  under  the  clavi- 
cle. The  cure  of  phthisis  is  possible,  since  autopsies 
show  us  how  nature  has  worked  a  transformation  in 
the  so-called  ulcers  of  the  lungs,  that  is,  tuberculous 
cavities.  Laennec  had  little  faith  in  the  therapeutic 
value  of  medicines,  etc.,  in  cases  of  phthisis.  He  ad- 
vocated, rather,  hygienic  treatment  —  nourishing 
food,  travel,  and  fresh  air,  particularly  sea  air. 

In  the  judgment  of  Laennec  aegophony  (ai£, 
atyos,  wild  goat,  (JHOVTJ,  sound)  was  indicative  of 
pleurisy  attended  by  a  moderate  effusion  in  the 
pleura,  or  of  hydrothorax  or  other  extravasation  in 
the  chest  cavity.  Simple  aegophony  is  described  by 


214    THE  HISTORY  OF  MEDICINE 

him  as  a  peculiar  sound  of  the  voice  accompanying 
or  following  the  articulation  of  words.  He  speaks 
of  it  as  a  kind  of  silvery  voice,  of  a  sharper  and 
shriller  tone  than  that  of  the  patient.  It  seems  to 
vibrate  on  the  surface  of  the  lungs,  more  like  the 
echo  of  the  voice  than  the  voice  itself.  "It  has,  more- 
over, another  character,  so  constant  as  to  lead  me  to 
derive  from  it  the  appellation  of  the  phenomenon  — 
I  mean  a  trembling  or  bleating  sound  like  the  voice 
of  a  goat,  a  character  which  is  the  more  striking  be- 
cause the  key  or  tone  of  it  approaches  that  of  this 
animal's  voice."  In  another  passage  Laennec  says 
that  segophony  is  characterized  by  the  harsh,  trem- 
ulous, silvery  tones  of  the  voice,  which  is  commonly 
shriller  than  the  natural  voice  of  the  patient,  and 
seems  to  be  quite  superficial,  and  to  float,  as  it  were, 
on  the  surface  of  the  lungs,  instead  of  coming  from 
the  interior,  like  pectoriloquy  or  bronchophony. 
Laennec  sought  to  produce  experimentally  the 
tremulous  echo  of  a  voice  that  seemed  to  him  to 
occur  in  pleurisy  with  effusion,  and  other  forms  of 
thoracic  disease.  Accordingly,  before  applying  the 
stethoscope  he  placed  a  bladder  half  filled  with 
water  between  the  scapulae  of  a  young  man  with  a 
well-marked  natural  bronchophony  at  this  point. 
The  stethoscopic  sound  seemed  sharper  and  also 
slightly  tremulous.  A  like  experiment  tried  over  the 
larynx  seemed  to  give  the  like  result. 


LOCAL  DIAGNOSIS  215 

We  owe,  of  course,  to  the  investigations  of  Laen- 
nec  our  knowledge  of  the  various  rales  and  their 
diagnostic  significance.  In  his  classic  description  of 
lobar  pneumonia  we  find  the  stages  revealed  by 
post-mortem  examination  coupled  with  the  physical 
signs  —  the  early  crepitant  rale,  and  the  mucous 
rale  that  accompanies  resolution.  He  held  that  a 
metallic  tinkle  could  be  heard  in  hydro-pneumo- 
thorax  or  pyo-pneumothorax.  Surpassing  the  work 
of  Bichat  he  gave  a  masterly  description  of  bron- 
chitis with  its  sonorous  and  sibilant  rales.  He  de- 
scribed also  the  rdle  humide  and  the  souffle.  We  are 
indebted  to  Laennec  for  descriptions  of  bronchiec- 
tasis,  oedema  of  the  lungs,  pulmonary  "apoplexy," 
hsemorrhagic  pleurisy,  gangrene  of  the  lungs  and 
emphysema.  It  seemed  to  him  that  vesicular  emphy- 
sema is,  next  to  hypertrophy,  the  simplest  of  all  the 
organic  lesions  of  the  lungs,  since  it  consists  merely 
in  the  dilatation  of  the  air  cells.  On  this  account  it 
remained  long  unknown,  and  had,  he  thought,  not 
been  correctly  described  by  any  author  before  his 
time.  "I,"  he  continues,  "for  a  long  time  thought 
it  very  uncommon,  because  I  had  observed  only  a 
few  cases  of  it;  but  since  I  have  made  use  of  the 
stethoscope,  I  have  verified  its  existence  as  well  on 
the  living  as  the  dead  subject,  and  am  led  to  con- 
sider it  by  no  means  infrequent."  In  some  cases  the 
lung  takes  on  a  striking  resemblance  to  the  vesicular 
lungs  of  Reptilia. 


216    THE  HISTORY  OF  MEDICINE 

It  did  not  occur  to  Laennec  to  make  use  of  the 
stethoscope  in  the  diagnosis  of  pregnancy.  This  idea 
came  first  to  his  friend  Dr.  Kergaradec  while  verify- 
ing the  facts  contained  in  the  first  edition  of  "  Medi- 
ate Auscultation."  Dr.  Kergaradec's  conclusions 
are  stated  in  the  appendix  of  the  second  edition  of 
that  work.  In  putting  his  idea  to  the  test  he  ob- 
served the  fcetal  heart-beat,  as  well  as  the  placental 
bruit,  in  a  woman  very  near  her  confinement.  The 
latter  he  described  as  an  arterial  pulsation  accom- 
panied by  a  bellows  sound.  The  fcetal  pulse,  which 
is  distinctly  audible  in  the  sixth  month  and  some- 
times a  little  earlier,  is  usually  twice  as  rapid  as  that 
of  the  mother.  The  placental  sound,  which  is  usually 
perceptible  about  the  fourth  month,  is,  on  the  other 
hand,  isochronous  with  the  pulse  of  the  mother. 

"Laennec,"  says  Osier,  "laid  the  foundations  not 
only  of  our  modern  knowledge  of  tuberculosis,  but 
of  modern  clinical  medicine."  By  the  invention  of 
the  stethoscope  he  brought  into  play  one  of  the 
higher  senses  and  armed  the  profession  with  the 
means  of  a  more  adequate  diagnosis.  He  did  not 
underrate  his  own  achievement,  holding,  as  he  did, 
to  the  Hippocratic  conviction  that  theory  must  rest 
on  observation,  and  adopting  as  the  motto  of  his 
work:  An  important  part  of  the  art  is  in  my  judg- 
ment to  be  able  to  explore  (/w-eya  Se  /aeXos  ^yevjucu 
Tijs  T€)(i>fjs  elvaLTo  ^vva.dda.i  (TKOTreiy).  Very  much  of 


LOCAL  DIAGNOSIS  217 

LaSnnec's  work  was  so  well  done  that  it  needs  to-day 
little  change  in  the  way  either  of  correction  or  addi- 
tion. In  the  diagnosis  of  diseases  of  the  heart  his 
endeavors  were  soon  supplemented  by  the  investi- 
gations of  his  disciples  of  the  Dublin  School  and 
other  great  leaders  in  clinical  medicine. 

After  completing  the  second  edition,  which  was 
almost  a  new  work,  of  the  "  Mediate  Auscultation," 
Laennec  once  more  retired  to  Finistere  in  the  hope 
of  again  reestablishing  his  health.  The  sea  breezes 
and  outdoor  life  failed,  however,  to  revive  his  pow- 
ers, exhausted  by  years  of  constant  activity,  and 
August  13,  1826,  he  succumbed  to  one  of  those  dis- 
eases from  which  his  genius  has  rescued  so  many 
victims. 

REFERENCES 

Camac,  C.  N.  B.:  Epoch-making  Contributions  to  Medicine  and 

Surgery.    1909. 

Meunier,  L.:  Histoire  de  la  Medecine.   1911. 
Thayer,    W.    S.:     "Laennec  —  One    Hundred    Years  After," 

Canadian    Medical    Association    Journal,    vol.    IX,    no.    9, 

Sept.,  1919. 
Walsh,  J.  J.:  Makers  of  Modern  Medicine.  Third  edition,  1915. 


CHAPTER  XI 
ADVANCES  IN   PHYSIOLOGY 

AMONG  the  many  advances  in  physiology  in  the 
nineteenth  century  must  be  mentioned  above  all  the 
progress  made  in  the  study  of  the  functions  of  the 
nervous  system  through  the  investigations  of  the 
experimental  physiologists,  Charles  Bell,  Magendie, 
Marshall  Hall,  Johannes  M tiller,  and  Claude  Ber- 
nard. For  this  progress  the  way  had  been  prepared 
by  Albrecht  von  Haller.  Born  at  Berne,  Switzerland, 
October  16,  1708,  Haller  was  favored  by  striking 
natural  endowments,  as  well  as  by  almost  unlimited 
opportunities  for  education.  The  accounts  of  his 
linguistic,  literary,  and  scientific  attainments  while 
he  was  still  little  more  than  a  child  are  not  far  from 
incredible.  His  more  advanced  education  began  at 
Tubingen,  where  he  studied  anatomy  and,  under  the 
direction  of  Camerarius,  botany.  From  Tubingen  he 
was  drawn  to  Leyden  by  the  reputation  of  Boer- 
haave.  After  graduating  at  the  age  of  nineteen,  he 
visited  England,  where  he  came  in  contact  with  some 
of  the  leading  British  scientists.  At  Paris  he  came 
under  the  influence  of  the  anatomist  Winslow,  and, 
at  Basel,  before  returning  to  his  native  city,  he 
studied  mathematics  under  Jean  Bernouilli.  In 


ADVANCES  IN  PHYSIOLOGY      215 

1736  Haller,  after  years  of  private  practice,  of  a 
limited  sort,  and  much  study,  was  induced  by 
George  II  of  England  to  accept  a  professorship  of 
medicine,  anatomy,  botany,  and  surgery  in  the 
newly  established  university  of  Gottingen.  Here  as 
elsewhere  he  was  indefatigable.  After  seventeen 
years'  activity  at  this  Hanoverian  seat  of  learning 
he  returned  to  his  native  Berne,  where  he  spent  the 
remaining  twenty-four  years  of  his  life. 

Of  Haller's  many  claims  to  distinction  his  work  as 
a  physiologist  is  the  most  convincing,  though  his 
knowledge  of  human  and  animal  structure,  on  which 
his  knowledge  of  physiological  function  was  based, 
was  very  thorough.  Haller's  influence  increased  the 
range  of  experiments  on  living  animals.  He  de- 
clared that,  in  spite  of  its  apparent  cruelty,  vivisec- 
tion is  of  more  value  in  the  study  of  physiology  than 
all  other  methods  and  that  a  single  experiment  of 
this  kind  has  often  cleared  up  misconceptions  solu- 
ble by  no  other  means  of  investigation.  The  func- 
tion and  structure  of  mammals,  birds,  fishes,  and 
still  lower  forms  of  life,  helped  him  to  explain  the 
anatomy  and  physiology  of  man. 

Haller  laid  the  progress  of  physiology  under  par- 
ticular obligation  by  his  experiments  on  muscles  and 
nerves  and  by  the  doctrine  he  based  on  these  experi- 
ments. In  1752  they  were  reported  to  the  Royab 
Society  of  Gottingen,  of  which  he  was  the  founder 


220    THE  HISTORY  OF  MEDICINE 

and  president.  He  taught  that  irritability  is  the  in- 
herent property  of  muscle,  while  sensibility  is  the 
characteristic  property  of  nerves.  He  used  the  term 
"irritability"  in  the  sense  of  "contractility";  that 
is,  in  a  much  more  restricted  sense  than  Glisson,  who 
in  1677  had  spoken  of  the  irritability  of  all  animal 
tissues.  Haller  admitted  that  the  usual  stimulation 
which  brings  about  the  contraction  of  a  muscle  is 
conveyed  by  means  of  the  nerves.  Yet  for  this 
means  of  stimulation  there  might  be  substituted 
other  forms  which  prove  effective  even  when  the 
connection  between  the  nerve  and  the  muscle  is 
severed.  It  is  the  function  of  the  nerves,  on  the 
other  hand,  to  transmit  to  the  consciousness  the 
changes  called  forth  by  peripheral  stimuli;  or,  in 
other  words,  the  nerves  are  exclusively  the  organs 
of  sensibility.  For  example,  the  retina  is  a  network 
of  nerve  fibers  which  serve  to  transmit  sensations  of 
light.  The  rays  of  light  coming  from  the  object  be- 
fore us  produce  an  impression  on  the  retina  which 
constitutes  a  stimulus  of  the  optic  nerve.  What  we 
feel  is  not  the  object  itself,  but  the  impression  which 
the  object  makes  on  the  particular  nerve  in  question. 
It  would  seem  to  follow  from  this  that  the  nerve  of 
each  sense  has  its  own  special  mode  of  responding  to 
stimulation,  and  that  sensations  are  subjective  in 
character,  though  they  afford  grounds  for  arriving 
at  a  judgment  in  reference  to  the  nature  of  the  outer 


ADVANCES  IN  PHYSIOLOGY     221 

world.  Irritability  may  be  found  in  detached  parts 
of  the  body  quite  withdrawn  from  the  empire  of  the 
soul.  It  is  therefore  absurd  to  seek  to  identify  the 
soul  with  mere  irritability.  The  nerves,  the  true 
organs  of  sensibility,  contain,  Haller  was  inclined  to 
believe,  a  subtle,  automatic  fluid,  being  influenced 
no  doubt  in  this  belief  by  the  contemporary  dis- 
coveries in  electricity.  He  also  taught  that  memory 
is  developed  through  the  persistence  of  impressions 
on  the  brain  substance. 

In  1811  Sir  Charles  Bell  (1774-1842)  circulated  a 
privately  printed  pamphlet,  "An  Idea  of  a  New 
Anatomy  of  the  Brain."  In  this  occurred  this  pas- 
sage: "On  laying  bare  the  roots  of  the  spinal  nerves 
I  found  that  I  could  cut  across  the  posterior  fascicu- 
lus of  nerves  which  took  its  origin  from  the  posterior 
portion  of  the  spinal  marrow  without  convulsing  the 
muscles  of  the  back,  but  that  on  touching  the  an- 
terior fasciculus  with  the  point  of  the  knife  the 
muscles  of  the  back  were  immediately  convulsed." 
In  his  work  "The  Anatomy  of  the  Human  Body" 
(7th  edition)  he  admitted  that  sensibility  is  indeed 
seated  in  the  nerves,  but  that  is  only  one  of  their 
functions.  There  are  nerves  which  possess  no  sensi- 
bility at  all.  He  was  led  to  surmise  this  difference  of 
function  by  observing  beforehand  differences  of 
structure,  being  early  struck  by  the  perfect  regular- 
ity of  the  spinal  nerves  as  contrasted  with  the  very 


222    THE  HISTORY  OF  MEDICINE 

great  irregularity  of  the  cranial  nerves.  He  argued 
that  if  the  endowment  of  a  nerve  depend  on  the  rela- 
tion of  its  roots  to  the  columns  of  the  spinal  marrow 
and  the  base  of  the  brain,  then  the  observation  of 
their  roots  must  indicate  to  us  their  true  distinction 
and  their  different  uses.  It  was  necessary  to  know 
in  the  first  place  whether  the  phenomena  exhibited 
on  injuring  the  separate  roots  of  the  spinal  nerves 
correspond  with  what  was  suggested  by  their  anat- 
omy. He  hesitated  to  put  the  question  to  the  test  of 
experiment  because  of  the  cruelty  that  seemed 
necessarily  involved.  It  finally  occurred  to  him, 
however,  that  it  was  best  to  experiment  on  an  ani- 
mal in  a  state  of  insensibility,  as  otherwise  it  might 
be  difficult  to  distinguish  between  the  expression  of 
pain  and  the  effect  produced  through  the  motor 
nerves. 

"I  therefore,"  he  continues,  "struck  a  rabbit 
behind  the  ear,  so  as  to  deprive  it  of  sensibility  by 
the  concussion,  and  then  exposed  the  spinal  marrow. 
On  irritating  the  posterior  roots  of  the  nerve,  I 
could  perceive  no  motion  consequent,  on  any  part 
of  the  muscular  frame;  but  on  irritating  the  anterior 
roots  of  the  nerve,  at  each  touch  of  the  forceps  there 
was  a  corresponding  motion  of  the  muscles  to  which 
the  nerve  was  distributed.  These  experiments  satis- 
fied me  that  the  different  roots  and  the  different 
columns  from  whence  these  roots  arose,  were  devoted 


SIR  CHARLES  BELL 


ADVANCES  IN  PHYSIOLOGY      223 

to  distinct  offices,  and  that  the  notions  drawn  from 
the  anatomy  were  correct."  In  a  paper  communi- 
cated to  the  Royal  Society  of  London  in  1821,  we 
find  Sir  Charles  Bell  pursuing  a  similar  line  of  argu- 
ment and  reporting  a  similar  method  of  investiga- 
tion in  reference  to  the  function  of  one  of  the  cranial 
nerves.  He  drew  attention  to  the  complicated  nerve 
supply  of  the  face,  inexplicable  on  the  assumption 
that  the  nerves  are  confined  to  a  single  function. 
He  maintained  that  an  organ  that  has  only  one  func- 
tion has  only  one  nerve,  and  assumed  that  the  pres- 
ence of  a  number  of  nerves  supplying  the  same  part 
of  the  body  gave  ground  for  surmising  a  variety  of 
function.  He  submitted  to  special  examination  the 
facial  nerve  (portio  dura),  the  branches  of  which  are 
so  largely  concerned  in  the  expression  of  the  emo- 
tions, and  the  paralysis  of  which  gives  rise  to  what 
is  now  known  as  Bell's  palsy.  He  produced  artificial 
paralysis  in  experimental  animals  by  dividing  the 
nerve  after  its  emergence  from  the  stylo-mastoid 
foramen.  The  cutting  of  the  nerve  called  forth  no 
sign  of  pain.  The  muscles  of  the  side  of  the  face  on 
which  the  nerve  was  cut  no  longer  acted  in  harmony 
with  the  other  muscles  involved  in  the  act  of  respira- 
tion, and  in  the  expression  of  emotion  so  closely  as- 
sociated with  respiratory  movements.  If  the  facial 
nerve  of  one  side  of  the  face  is  cut  and  that  of  the 
other  left  intact  and  the  animal  is  bled  to  death,  the 


224    THE  HISTORY  OF  MEDICINE 

contrast  in  expression  between  the  two  sides  of  the 
face  of  the  dying  animal  is  most  striking. 

The  different  functions  of  the  nerves  afford  a  clue 
to  the  functions  of  the  brain  and  spinal  cord.  Some 
of  the  nerve  trunks  are  made  up  of  filaments  that 
merely  convey  sensations ;  while  other  nerve  trunks 
are  made  up  of  filaments  that  merely  convey  motor 
impressions  to  the  muscles:  a  third  class  of  nerve 
trunks  are  made  up  of  the  two  kinds  of  filaments, 
as  we  have  seen  in  the  case  of  the  spinal  nerves. 
The  brain  and  cord  in  turn  are  divided  into  parts 
concerned  respectively  with  sensations  and  bodily 
movements.  By  many  authorities  in  physiology 
Bell's  contribution  to  neurology  has  been  compared 
in  value  with  Harvey's  discovery  of  the  circulation 
of  the  blood.  As  early  as  November  26,  1807,  Bell 
had  written  to  his  brother:  "I  have  done  a  more 
interesting  nova  anatomia  cerebri  humani  than  it  is 
possible  to  conceive.  I  lectured  it  yesterday.  I 
prosecuted  it  last  night  till  one  o'clock;  and  I  am 
sure  it  will  be  well  received." 

Francois  Magendie,  who  founded  the  "Journal  de 
physiologic  exp6rimentale "  in  1821,  confirmed  in 
the  following  year,  by  experiments  on  a  litter  of 
eight  puppies  six  weeks  old,  the  results  obtained  by 
Sir  Charles  Bell  in  reference  to  the  functions  of  the 
roots  of  the  spinal  nerves.  At  that  time  Magendie 
had  not  heard  of  Bell's  experiments  to  determine 


ADVANCES  IN  PHYSIOLOGY     225 

these  functions.  First  he  cut,  in  one  of  the  litter  of 
pups,  the  posterior  roots  of  the  lumbar  and  sacral 
nerves  of  one  side,  leaving  the  posterior  roots  on  the 
other  side  uncut  in  order  that  he  might  have  a  basis 
of  comparison.  The  parts  of  the  body  to  which  the 
cut  nerves  were  distributed  were  still  capable  of 
movement,  though  their  sensibility  was  wholly  ex- 
tinct. A  second  experiment  of  the  same  description, 
and  a  third,  showed  like  results.  Magendie  then 
succeeded  in  another  pup  in  cutting  the  anterior 
roots  of  the  lumbar  and  sacral  nerves  of  one  side. 
The  results  here  also  were  not  hard  to  interpret,  the 
part  of  the  body  concerned  becoming  completely 
motionless  and  lax,  while  retaining  its  sensibility. 
"Finally,"  writes  Magendie,  "to  neglect  nothing,  I 
cut  the  anterior  and  the  posterior  roots  at  the  same 
time;  there  was  then  an  absolute  loss  of  sensibility 
and  movement."  He  concluded  from  this  investiga- 
tion that  the  anterior  and  posterior  roots  have  differ- 
ent functions,  in  fact,  "that  the  posterior  appear 
more  particularly  destined  for  sensibility,  while  the 
anterior  seem  more  especially  connected  with  move- 
ment." 

Just  three  months  later  Magendie  published  an 
account  of  further  experiments  bearing  on  the  func- 
tions of  the  roots  of  the  spinal  nerves.  Interested  in 
the  action  of  drugs  —  morphine,  strychnine,  eme- 
tine, veratrine,  brucine,  piperine,  bromine,  iodine, 


226    THE  HISTORY  OF  MEDICINE 

and  prussic  acid  —  as  well  as  in  the  functions  of  the 
nerves,  he  gave  nux  vomica  to  experimental  animals 
and  noted  the  modification  of  the  action  of  the  poison 
produced  by  cutting  one  or  the  other  set  of  roots  of 
certain  spinal  nerves.  If  the  posterior  roots  alone 
were  cut,  tetanus  was  complete.  When  the  anterior 
roots  of  the  nerves  supplying  the  hind  leg  were  cut, 
this  member  remained  supple  and  motionless,  while 
under  the  influence  of  the  poison  all  the  rest  of  the 
body  was  thrown  into  convulsions. 

In  1833  Marshall  Hall  read  before  the  Royal  So- 
ciety a  paper  On  the  Reflex  Function  of  the  Medulla 
Oblongata  and  Medulla  Spinalis.  Consciously  bas- 
ing his  investigation  on  the  work  with  decerebrated 
animals  of  certain  French  physiologists,  Hall  was 
particularly  interested  in  phenomena  brought  about 
by  eccentric,  or  peripheral,  stimulation.  He  wished 
to  distinguish  these  phenomena  from  sensation  and 
volition,  the  characteristic  functions  of  the  cere- 
brum. Among  these  phenomena  he  mentions  wink- 
ing, sneezing,  coughing,  swallowing,  vomiting,  tenes- 
mus  and  the  maintenance  of  equilibrium.  In  the 
reflex  function  the  muscles  are  excited  by  a  stimulus 
acting  along  nerves  proceeding  to  the  medulla  and 
muscular  nerves  proceeding  from  the  medulla.  The 
reflex  function  keeps  the  glottis  open,  through  the 
superior  laryngeal  nerve  connected  with  the  cord, 
and  keeps  the  sphincters  closed.  Infants  born  with- 


ADVANCES  IN  PHYSIOLOGY     227 

out  cerebrum  or  cerebellum  are  capable  of  sucking, 
grasping,  and  crying.  Strangury  may  be  caused  re- 
flexly  by  the  irritation  of  the  rectum.  Reflex  action 
is  increased  by  strychnine  and  opium,  decreased  by 
hydrocyanic  acid. 

In  reaching  his  illuminating  conclusions  Marshall 
Hall  had  experimented  with  snakes,  turtles,  frogs, 
toads,  newts,  and  guinea-pigs.  He  tells  particularly 
of  dividing  the  spinal  marrow  of  a  very  lively  snake 
(coluber  natrix),  between  the  second  and  third 
vertebrae.  "From  the  moment  of  the  division  of 
the  spinal  marrow,  it  lay  perfectly  tranquil  and 
motionless,  with  the  exception  of  occasional  gasping 
and  slight  movements  of  the  head."  Upon  stimula- 
tion, however,  the  body  began  to  move  with  great 
activity.  When  carefully  protected  "from  all  ex- 
ternal impressions,  it  moved  no  more,  but  died  with 
the  precise  position  and  form  which  it  had  last  as- 
sumed." Hall  argued  that  sensation  can  act,  in  in- 
ducing muscular  motion,  only  through  the  medium 
of  volition;  that,  in  the  experiments  which  were  per- 
formed by  him,  volition,  that  is,  the  will,  and  not 
the  power,  to  move,  was  annihilated;  that  in  such 
cases  —  volition  being  destroyed  and  the  agency  of 
sensation  excluded  —  the  influence  of  external  im- 
pressions, which  might  be  supposed  to  induce  pain, 
must  have  been  exerted  upon  some  property  of  the 
nervous  system  different  from  sensibility.  In  fine, 


228    THE  HISTORY  OF  MEDICINE 

in  Hall's  judgment  the  cerebrum  is  the  source  of 
voluntary  emotions,  the  medulla  oblongata  the 
source  of  respiratory  motions,  the  medulla  spinalis 
the  middle  arc  of  the  reflex  function,  the  sympathetic 
nervous  system  the  source  of  nutrition,  secretion, 
etc. 

About  ten  years  after  Magendie  had  given  clear 
experimental  proof  of  the  difference  in  function  of 
the  anterior  and  posterior  roots  of  the  spinal  nerves, 
a  further  confirmation  of  Bell's  view  was  afforded  by 
the  great  German  scientist  Johannes  Miiller  (1801- 
58),  who  has  been  called  the  founder  of  scientific 
medicine  in  Germany.  "The  happy  thought  at 
length  occurred  to  me,"  he  writes,  "of  performing 
the  experiment  on  frogs.  The  result  was  most  satis- 
factory. The  experiments  are  so  easily  performed,  so 
certain  and  conclusive,  that  every  one  can  now  read- 
ily convince  himself  of  one  of  the  most  important 
truths  of  physiology.  ...  It  is  quite  impossible  to 
excite  muscular  contractions  in  frogs  by  irritating 
mechanically  the  posterior  roots  of  the  spinal 
nerves;  while,  on  the  other  hand,  the  slightest  irrita- 
tion of  the  anterior  roots  immediately  gives  rise  to 
strong  action  of  the  muscles.  .  .  .  The  application  of 
galvanism  to  the  anterior  roots  of  the  spinal  nerves, 
after  their  connection  with  the  cord  is  divided,  ex- 
cites violent  muscular  twitchings;  the  same  stimu- 
lus applied  to  the  posterior  roots  is  attended  by  no 


ADVANCES  IN  PHYSIOLOGY     229 

such  effects.  ...  If  in  the  same  frog  the  three  poste- 
rior roots  of  the  nerves  going  to  the  hinder  extremi- 
ties be  divided  on  the  left  side,  and  the  three  an- 
terior roots  on  the  right  side,  the  left  extremity  will 
be  deprived  of  sensation,  the  right  of  motion." 

M tiller  must  also  be  held  responsible  for  formu- 
lating the  so-called  law  of  the  specific  energy  of  the 
nerves.  We  find  it  as  an  implicit  assumption  in  the 
works  of  Haller  and  other  physiologists.  John 
Hunter  had  stated  that  the  only  kind  of  sensations 
obtained  by  stimulating  the  optic  nerve  are  sensa- 
tions of  light,  irrespective  of  the  nature  of  the 
stimulus.  According  to  M  tiller  the  nature  of  the 
sensation  depends  not  on  outside  objects  but  on  the 
native  substance  of  the  sensory  nerve  involved  in 
the  sensation.  For  example,  the  optic  nerve  cannot 
be  stimulated  without  giving  rise,  in  accordance 
with  its  inherent  energy,  to  sensations  of  light  and 
color.  Light  and  color  do  not  exist  as  something 
fixed  and  objective  which,  affecting  the  sense  of 
sight,  calls  forth  a  corresponding  sensation ;  but  the 
mechanism  of  sight  produces  always  sensations  of 
the  same  mode  whatever  may  be  the  nature  of  the 
stimulus.  Similarly,  the  auditory  nerve  cannot  be 
stimulated  without  giving  rise  to  auditory  sensa- 
tions ;  the  gustatory  nerve  causes  only  sensations  of 
taste.  The  character  of  the  stimulus  may  be  mani- 
fold, as  we  all  know  in  the  sense  of  sight:  pressure, 


230    THE  HISTORY  OF  MEDICINE 

percussion,  friction,  heat,  cold,  electricity,  chemical 
reagents,  the  throbbing  of  an  artery,  an  inflamma- 
tion of  the  retina.  Whatever  stimulates  the  optic 
nerve  serves  to  dispel  the  sensation  of  darkness  and 
to  substitute  sensations  of  light  and  color,  just  as  by 
a  stimulation  of  the  motor  nerves  no  effect  may  fol- 
low except  the  contraction  of  the  muscles  to  which 
the  nerves  in  question  are  distributed.  It  follows, 
of  course,  from  this  doctrine  of  the  specific  energy 
of  the  sensory  nerves  that  our  sensations  do  not  re- 
veal the  essential  qualities  of  the  objective  world. 
Our  knowledge  of  outside  things  is  limited  by  our 
knowledge  of  the  sensations  aroused  in  us  by  stimuli. 
At  the  present  time  physiologists  and  psychologists 
believe  as  a  rule  that  the  nerve  fibers  are  mere  con- 
ductors, and  that  the  specific  differences  of  sensa- 
tions depend  on  the  nature  of  the  receptors,  the  in- 
born organization  of  the  cortical  areas  to  which  the 
afferent  impulses  are  conducted,  or  on  both  of  these. 
Johannes  M tiller  stands  out  as  one  of  the  greatest 
leaders  in  the  progress  of  physiology.  The  compre- 
hensiveness of  his  interests  as  reflected  in  his  two 
volumes,  "Handbuch  der  Physiologic  des  Men- 
schen"  (1833-40),  the  comparative  character  of  his 
physiology,  his  recognition  of  the  dependence  of 
psychology  on  physiology  (in  which  he  followed  the 
lead  of  Cabanis,  the  real  founder  of  physiological 
psychology),  and  his  striking  personality,  contrib- 


ADVANCES  IN  PHYSIOLOGY     231 

uted  to  make  him  a  wonderfully  inspiring  influence. 
Following  the  example  of  Virchow,  many  speakers 
and  writers  have  said  that  there  was  something 
superhuman  about  Johannes  Miiller.  Adopting  this 
point  of  view,  one  should  hasten  to  add  that  his  was 
a  sort  of  immanent  divinity  that  wrought  its  most 
notable  achievements  by  purely  human  instru- 
mentality. While  no  single  first-class  contribution 
to  physiology  stands  to  his  credit,  the  labors  of  his 
pupils  bear  witness  to  the  commanding  character  of 
his  genius.  Let  it  suffice  here  to  mention  Helmholtz, 
the  inventor  of  the  ophthalmoscope  and  the  ophthal- 
mometer,  who  measured  the  velocity  of  the  nervous 
impulse,  and  was  no  less  distinguished  in  acoustics 
than  in  optics;  Du  Bois-Reymond,  who  brought  the 
apparatus  of  the  physicist  to  bear  on  the  study  of 
the  nerves  and  muscles;  and  Briicke,  who  carried 
Miiller's  influence  to  Vienna. 

Claude  Bernard  (1813-77)  advanced  the  study  of 
the  functions  of  the  nerves  (to  which  Bell,  Magendie, 
Hall,  and  Miiller  so  notably  contributed)  and 
furthered  remarkably  the  solution  of  problems  in 
other  departments  of  physiology.  He  was  born  near 
Lyons,  studied  medicine  at  Paris,  and,  after  taking  his 
degree,  became  an  interne  at  the  Hotel  Dieu  under 
the  superintendence  of  Magendie,  and  in  1841  was 
appointed  assistant  (preparateur)  in  Magendie's 
laboratory  at  the  College  de  France.  In  1839 


232    THE  HISTORY  OF  MEDICINE 

Magendie,  on  the  basis  of  experiments  on  the  roots 
of  the  spinal  nerves,  claimed  that  the  anterior  roots, 
though  motor,  were  not  wholly  devoid  of  sensibility. 
This  claim  that  there  existed  in  the  anterior  roots  a 
sensibiliti  en  retour,  or,  as  it  was  afterwards  called, 
sensibilite  recurrente,  was  vigorously  disputed,  and 
it  was  only  after  a  long  series  of  experiments  on  dogs 
conducted  by  Magendie  and  Bernard  that  the  claim 
was  upheld.  According  to  Bernard  by  means  of  the 
sensory  fibers  from  the  posterior  root  which  find 
their  way  into  the  anterior  root  a  functional  har- 
mony is  established  in  the  sensory-motor  mechan- 
ism. For  him  the  reflex  movements,  studied  as  he 
notes  by  Hall  and  Johannes  Miiller,  are  the  simplest 
of  all.  "The  excitation  carried  by  the  sensory  nerve 
arrives  at  the  cord,  it  is  propagated  through  the  cord 
to  the  anterior  root,  and  through  the  latter  to  the 
muscles." 

By  a  series  of  experiments  begun  in  1852  he  de- 
cided the  old  question  of  the  independent  irritability 
of  muscular  tissue.  He  was  well  aware  that  the 
problem  of  the  relation  between  nervous  excitability 
and  muscular  contractility  had  been  under  discus- 
sion since  the  time  of  Haller.  Curare,  however,  was 
in  Bernard's  hands  the  means  of  reaching  a  clear 
decision,  for  it  kills  completely  the  motor  nervous 
system  without  diminishing  the  range  of  contraction 
of  muscles.  Bernard  injected  curare  under  the  skin 


ADVANCES  IN  PHYSIOLOGY     233 

of  a  frog.  He  decapitated  a  second  frog,  laying  bare 
the  lumbar  nerves.  When  the  first  frog  was  dead, 
he  stimulated  the  hind  legs  of  both  by  means  of  an 
electric  current  applied  to  the  nerves.  The  muscles 
of  the  frog  poisoned  by  curare  did  not  contract 
under  these  conditions.  When,  however,  the  cur- 
rent was  applied,  not  to  the  nerve,  but  directly  to  the 
muscles,  the  contractions  were  as  marked  in  the  one 
case  as  in  the  other. 

In  1851  Bernard  began  to  investigate  the  function 
of  the  sympathetic  nervous  system,  starting  from 
the  hypothesis  that  the  sympathetic  nerves  were 
the  producers  of  heat.  On  this  assumption  he  cut 
the  cervical  sympathetic  of  a  rabbit.  Contrary  to 
his  expectation  there  was  a  decided  rise  instead  of  a 
fall  in  temperature,  and  the  increased  temperature 
was  accompanied  by  a  swelling  of  the  arteries  in  the 
external  ear.  Brown-Sequard,  at  that  time  in  Amer- 
ica, showed  that  the  stimulation  of  the  divided 
cervical  sympathetic  had  the  effect  of  decreasing 
the  blood  supply  and  the  temperature  in  the  ear  of 
the  rabbit.  Claude  Bernard  repeated  this  experi- 
ment and  verified  the  results  obtained  by  Brown- 
Sequard.  In  1858  Bernard  announced  the  discovery 
that  the  submaxillary  gland  secretes  under  the 
double  influence  of  the  chorda  tympani  and  branches 
of  the  cervical  sympathetic.  Both  of  these  nerves 
are  vaso-motor,  producing  their  effects  through  the 


234     THE  HISTORY  OF  MEDICINE 

unstriated  muscles;  for  example,  the  unstriated 
muscular  coat  of  the  arteries  discovered  by  Henle 
in  1840.  The  function  of  the  cervical  sympathetic 
is  as  a  rule  to  cause  a  narrowing  or  constriction  of 
the  vessels,  while  the  function  of  the  chorda  tym- 
pani  is  to  cause  a  widening  or  dilation  of  the  vessels. 
Thus  Claude  Bernard  completed  his  discovery  of 
the  vaso-motor  nerves,  that  is,  the  vaso-dilator  and 
the  vaso-constrietor.  He  also  opened  up  the  ques- 
tion of  the  inhibitory  functions  of  nerves  by  prov- 
ing (1846)  that  the  stimulation  of  the  vagus  arrests 
the  action  of  the  heart,  and  that  respiratory  move- 
ments are  checked  by  stimulating  the  superior 
laryngeal. 

Claude  Bernard's  doctor's  thesis  (1843)  had  been 
on  the  gastric  juice  in  digestion.  He  found  that  cane 
sugar  injected  into  the  veins  of  a  dog  is  excreted  in 
the  urine.  If,  however,  it  is  first  treated  with  gastric 
juice,  it  does  not  so  appear.  Seeking,  later,  to  find 
out  at  what  part  of  the  body  the  sugar  so  treated 
lost  its  identity,  he  came  upon  an  unexpected  result, 
namely  that  sugar  occurs  in  the  hepatic  vein  in 
greater  quantity  than  in  the  portal  vein.  Moreover, 
if  the  experimental  animal  be  fed  neither  sugar  nor 
starch,  the  sugar  in  the  blood  nevertheless  persists. 
He  obtained  sugar  from  the  liver  itself,  and,  later 
still,  isolated  glycogen.  It  appeared  then  that  the 
liver  has  two  functions,  and  that  one  of  its  secre- 


ADVANCES  IN  PHYSIOLOGY     235 

tions  is  an  "internal  secretion."  On  the  false  as- 
sumption that  the  vagus  nerve  might  influence  the 
hepatic  secretion,  he  punctured  the  floor  of  the 
fourth  ventricle,  and  produced  what  he  called  arti- 
ficial diabetes  (experimental  glycosuria),  in  1849. 
He  is  considered,  in  consequence  of  this,  the  founder 
of  experimental  medicine. 

About  1848  he  found  one  day  on  his  laboratory 
table  some  rabbits,  which  had  been  brought  in  from 
the  market.  He  noted  that  their  urine  was  clear  and 
acid,  like  that  of  carnivora.  He  then  fed  them  herbs, 
and,  as  he  had  anticipated,  their  urine  became  tur- 
bid and  alkaline.  After  they  had  gone  without  food 
for  a  considerable  time,  he  fed  them  cold  boiled  beef, 
which,  faute  de  mieux,  they  ate  readily  enough. 
Again  their  urine  became  clear  and  acid.  He  con- 
cluded that  all  animals  fasting  are  in  a  sense  car- 
nivorous, since  they  are  nourished  on  their  own 
tissues.  In  a  later  experiment  the  rabbits  were 
killed  after  a  full  meal.  He  found  that  the  lacteals 
were  white  in  the  lower  part  of  the  duodenum  about 
30  centimeters  below  the  pyloris.  This  struck  his 
attention,  as  with  dogs  in  similar  circumstances  he 
had  noted  the  whiteness  of  the  lacteals  at  the  upper 
part  of  the  duodenum.  He  noted  that  this  difference 
coincided  with  the  fact  that  in  the  dog  the  entrance 
of  the  pancreatic  duct  is  quite  near  the  pyloris, 
while  in  the  rabbit  its  entrance  is  very  low.  The 


236    THE  HISTORY  OF  MEDICINE 

idea  then  occurred  to  him  that  the  pancreatic  juice 
might  be  the  cause  of  the  emulsion  of  the  fatty 
matter  of  the  food,  and  thus  facilitate  its  absorption 
by  the  lacteals. 

Like  his  master  Magendie,  Claude  Bernard  was 
interested  in  the  action  of  poisons  (for  example, 
curare  and  carbon  monoxide)  and  had  constant  re- 
course to  vivisection.  Nevertheless,  their  methods 
of  investigation  were  in  at  least  one  respect  con- 
trasted. Magendie  called  himself  a  chiffonnier, 
thus  comparing  himself,  working  haphazard  in  the 
field  of  knowledge,  with  those  who  go  about  the 
town  picking  up  rags,  etc.  Bernard,  on  the  other 
hand,  always  had  a  definite  aim  in  view,  holding  an 
hypothesis  essential  to  successful  research,  though 
too  agile  mentally  to  neglect  the  clues  that  chance 
threw  in  his  way,  and  too  astute  to  be  blinded  by 
prepossessions.  "  Put  off  your  imagination,"  he  said, 
"as  you  take  off  your  overcoat,  when  you  enter  the 
laboratory;  but  put  it  on  again,  as  you  do  your  over- 
coat, when  you  leave  the  laboratory."  He  thought 
that  one  had  little  chance  of  finding  anything  unless 
he  knew  what  he  was  looking  for,  yet  in  his  own 
investigations  he  was  again  and  again  rewarded  by 
the  discovery  of  the  unexpected. 

REFERENCES 

Bell,  Sir  Charles:  "On  the  Nerves,"  Philosophical  Transactions, 
1821,  pp.  397-424. 


ADVANCES  IN  PHYSIOLOGY     237 

The  Anatomy  of  the   Human    Body.    3  vols.,    seventh 

edition,  1824. 
Bernard,    Claude:    Introduction  a   la   Medecine  Experimental. 

1865. 
Lemons  sur  la   Physiologic  et  la   Pathologic  du  Systeme 

Nerveux.   1858. 
Flourens,  M.  J.  P.:   Memoir  of  Magendie  (translation).  Annual 

Report,  Smithsonian  Institution,  1866,  pp.  91-125. 
Foster,  Sir  Michael:   Claude  Bernard.   (Masters  of  Medicine.) 
Hadley,  P.  B.:  "Johannes  M  tiller,"  Popular  Science  Monthly, 

vol.  72  (1908),  pp.  513-33- 
Hall,  Marshall:  "On  the  Reflex  Function  of  the  Medulla  Ob- 

longata  and  Medulla  Spinalis,"  Philosophical  Transactions, 

1833,  pp.  635-65. 
Stirling,  Sir  William:  Some  Apostles  of  Physiology.  1902. 


CHAPTER  XII 
EMBRYOLOGY  AND  KARL  ERNST  VON  BAER 

THE  eighteenth  century  fell  heir  to  two  opposed 
theories  concerning  the  development  of  the  embryo 
—  epigenesis,  and  preformation  or  predelineation. 
They  were  supported  by  the  authority  of  the  two 
greatest  embryologists  of  the  preceding  century, 
Harvey  and  Malpighi.  Harvey  had  taught  that  the 
organism  is  built  up  gradually  by  the  addition  of 
part  to  part.  Malpighi,  on  the  other  hand,  had  held 
that  the  chick  existed  preformed  before  the  begin- 
ning of  incubation.  In  the  latter  view  two  other 
early  microscopists  had  concurred,  namely,  Swam- 
merdam  and  Leeuwenhoek.  The  first  of  these, 
whose  works  did  not  become  generally  known  till 
1737,  had  studied  the  early  stages  of  the  develop- 
ment of  the  frog,  and,  interested  in  the  meta- 
morphosis of  the  caterpillar,  had  observed  the  parts 
of  the  butterfly  in  the  chrysalis.  Leeuwenhoek 
(1632-1723)  was  the  first  to  describe  the  sperma- 
tozoa. It  would  seem  that  the  wonders  revealed  to 
these  early  students  of  microscopy  led  them  to  be- 
lieve that  further  revelations  of  minute  structures 
and  minute  organisms  only  awaited  the  develop- 
ment of  better  instruments  and  finer  technique. 


EMBRYOLOGY  AND  VON  BAER    239 

Moreover,  as  Professor  W.  M.  Wheeler  in  his  ad- 
mirable lecture  on  Wolff  has  indicated,  there  is  a 
class  of  mind  predisposed  to  emphasize  the  static 
rather  than  the  dynamic,  to  view  phenomena  as 
being  rather  than  becoming,  as  stable  rather  than 
transitional,  and  to  fasten  attention  on  the  fixity  of 
forms  and  species  rather  than  on  their  transforma- 
tions. 

The  investigations  of  Charles  Bonnet  (1720-93), 
and  the  authority  of  Haller,  also  favored,  in  the 
eighteenth  century,  the  inclination  to  believe  in  the 
doctrine  of  preformation.  While  still  a  youth,  Bon- 
net reported  his  observations  concerning  partheno- 
genesis in  plant-lice,  or  Aphides.  He  had  seen  a 
single  virgin  aphis  give  birth  to  ninety-four  daugh- 
ters, which  without  fertilization  continued  to  pro- 
duce after  their  kind.  Haller  declared  that  no  part 
of  the  animal  frame  was  made  after  the  other;  that 
all  were  made  together;  and  that  there  was  no  such 
thing  as  epigenesis.  It  follows  logically  from  the 
doctrine  of  preformation  that  the  ovum  contains  a 
complete  animal  that  awaits  the  process  of  unfolding 
or  evolution,  and  that  the  mother  of  the  race  bore 
within  her  all  her  posterity,  preformed  creatures 
impacted  in  preformed  creatures  like  a  series  of 
boxes  enclosed  in  boxes.  This  theory  of  embotie- 
ment,  was,  indeed,  definitely  taught  by  Bonnet, 
Leibnitz  and  others. 


240    THE  HISTORY  OF  MEDICINE 

Kaspar  Friedrich  Wolff  (1733-94)  opposed  the 
preformation  idea  in  his  Theory  of  Generation, 
which  appeared  first  as  a  doctor's  thesis  in  1 759.  It 
maintained  that  development  consists  in  a  series  of 
new  formations,  and  undertook  to  trace  the  stages 
by  which  the  organs  are  gradually  formed.  Accord- 
ing to  Wolff  the  theory  of  predelineation  merely 
affirms  the  fact  of  generation  without  offering  an 
explanation  of  the  process.  He  dealt  first  with  the 
structure  and  development  of  plants  in  order  to  dis- 
cover a  clue  to  the  more  difficult  problems  presented 
by  animals.  In  all  plants  little  globules  are  to  be  ob- 
served before  the  appearance  of  fibers  and  vessels. 
The  nutrient  sap  at  first  follows  the  path  of  least 
resistance;  the  vessels  are  formed  by  virtue  of  the 
hardening  of  the  liquid  nutriment.  This  principle  of 
coagulation  along  with  the  vis  essentialis  carports, 
the  force  through  which  the  liquids  in  the  organism 
are  distributed  and  eliminated,  is  the  cause  of  the 
process  of  development  in  all  organic  beings,  both 
plant  and  animal.  The  primordial  kidneys  (now 
frequently  called  Wolffian  bodies  in  honor  of  theii 
discoverer)  are  formed  by  the  urine  propelled  by  the 
essential  force  of  the  body.  The  globular  particles 
which  constitute  all  animal  organs  in  their  incep- 
tion —  heart,  blood-vessels,  limbs,  alimentary  canal, 
kidneys,  etc. —  may  always  be  distinguished  under  a 
microscope  of  moderate  magnification.  How,  then, 


EMBRYOLOGY  AND  VON  BAER     241 

can  the  predelineationists  claim  that  a  body  is  in- 
visible because  it  is  so  small,  when  the  parts  of  which 
it  is  composed  are  easily  distinguishable?  Wolff's 
drawings  illustrating  the  development  of  the  chick 
are,  on  the  whole,  inferior  to  those  made  by  Mal- 
pighi  in  1672  and  sent  to  the  Royal  Society  of 
London. 

Wolff's  opposition  to  the  doctrine  of  preforma- 
tion,  in  which  he  had  no  doubt  been  schooled  by  his 
Leibnitzian  professor  of  philosophy  Christian  Wolff, 
created  a  very  unfavorable  impression.  His  Theory 
of  Generation  implied  that  the  act  of  creation  was 
an  incomplete  process,  and  he  became  the  object  of 
the  same  sort  of  criticism  as  Darwin  incurred  just 
one  hundred  years  later.  He  was  warned  by  Haller 
of  the  danger  of  running  counter  to  the  teaching  of 
religion.  He  was  helpless  in  face  of  the  disapproba- 
tion he  encountered.  During  the  Seven  Years'  War 
he  served  in  the  military  hospitals  in  Schleswig  and 
lectured  on  anatomy  in  a  field  hospital  in  Breslau. 
But  the  support  that  this  patriotic  service  gained 
for  him  was  not  sufficient  to  overcome  the  hostility 
his  heresy  had  aroused.  He  was  refused  a  profes- 
sorship, and  even  forbidden  to  lecture  on  physiol- 
ogy in  Berlin.  In  1766  he  accepted  an  invitation 
to  the  Academy  of  Sciences  in  St.  Petersburg,  and 
he  spent  the  remainder  of  his  life  in  the  Russia  of 
Catherine  II. 


242    THE  HISTORY  OF  MEDICINE 

Wolff's  second  great  contribution  to  the  advance 
of  embryology,  "De  Formatione  Intestinorum," 
was  published  at  St.  Petersburg  in  1768  and  1769. 
Here,  speaking  of  the  development  of  the  anterior 
body  wall  of  the  chick,  he  says:  "This  is  one  of  the 
most  important  proofs  of  epigenesis.  We  may  con- 
clude from  it  that  the  organs  of  the  body  have  not 
always  existed,  but  have  been  formed  successively; 
no  matter  how  this  formation  has  been  brought 
about.  I  do  not  say  it  has  been  brought  about  by  a 
combination  of  particles,  by  a  kind  of  fermentation, 
through  mechanical  causes,  through  the  activity  of 
the  soul,  but  only  that  it  has  been  brought  about." 
As  implied  in  a  correspondence  with  Haller,  Wolff 
was  not  interested  in  proving  that  anything  is  true 
that  is  not  true,  and  he  accepted  it  as  axiomatic  that 
other  investigators  shared  his  simple  devotion  to  the 
truth.  This  study  of  the  development  of  the  intes- 
tines was  years  after  its  production  referred  to  by 
von  Baer  as  "die  grosste  Meisterarbeit,  die  wir  aus 
dem  Felde  der  beobachtenden  Naturwissenschaften 
kennen";  that  is,  the  most  masterful  performance 
known  to  us  in  the  field  of  the  observational  sciences. 
In  this  work  Wolff  anticipated  the  embryologists  of 
the  nineteenth  century  by  teaching  that  leaf-like 
embryonic  layers  give  rise  to  the  intestinal  canal, 
the  nervous  system,  the  vascular  system,  etc.  He 
furthered  the  study  of  embryology  by  applying  the 


EMBRYOLOGY  AND  VON  BAER     243 

method  of  strict  observation  in  this  difficult  field, 
and  by  establishing  a  definite  antithesis  between  the 
doctrine  of  epigenesis  and  the  theory  of  predelinea- 
tion  so  tenaciously  held  by  his  contemporaries. 

In  1812  the  "De  Formatione  Intestinorum"  was 
translated  into  German,  under  the  title  "Ueber  die 
Bildung  des  Darmkanals  im  bebriiteten  Hiihnchen," 
by  Johann  Friedrich  Meckel,  sometimes  called  the 
younger  to  distinguish  him  from  his  grandfather, 
J.  F.  Meckel,  whose  name  is  associated  with  the 
sphenopalatine  ganglion.  The  younger  Meckel  is 
famous  as  the  discoverer  of  Meckel's  diverticulum 
of  the  intestines,  which  represents  the  remains  of  the 
vitelline  duct,  and  as  the  author  of  an  extensive 
work  on  comparative  anatomy.  He  has  already 
been  mentioned  in  these  pages  as  having  some  ac- 
quaintance with  the  work  of  Hunter.  He  is  credited 
with  an  early  statement  of  the  recapitulation  theory, 
namely,  that  the  development  of  each  higher  animal 
is  "an  epitome  of  the  ancestral  stages  which  pre- 
ceded it"  (Garrison).  This  theory,  foreshadowed, 
as  we  have  seen,  in  the  writings  of  Hunter,  was  not 
accepted  by  von  Baer  without  limitation,  he,  in- 
deed going  so  far  as  to  say  that  the  embryos  of 
higher  forms  never  resembled  the  adult  stages  of  the 
lower  forms  but  merely  the  embryos  of  such  forms 
(Balfour).  This  theory,  severely  criticized  by  the 
embryologists  of  to-day  and  all  but  annihilated,  has 


244    THE  HISTORY  OF  MEDICINE 

served  to  stimulate  countless  investigators,  espe- 
cially since  Darwin's  "Origin  of  Species"  seemed  to 
lend  it  a  new  significance. 

Karl  Ernst  von  Baer  was  born  at  the  family 
estate  of  Priep  in  the  Russian  province  of  Esthonia, 
February  28,  1792.  He  passed  a  free  and  happy 
childhood  in  the  country.  At  the  age  of  eight  he  had 
not  learned  the  alphabet,  but  this  fact  did  not 
hamper  his  later  progress.  He  attended  school  at 
Reval,  and  spent  four  years  at  the  University  of 
Dorpat,  where  he  received  his  degree  as  doctor  of 
medicine  in  1814.  Following  his  graduation  he  went 
to  Vienna  to  complete  his  professional  studies,  but 
his  inclination  for  more  general  biological  research 
was  stimulated  by  a  chance  meeting  with  the  botan- 
ist Martius  in  the  spring  of  1815.  He  decided  to  put 
himself  under  the  instruction  of  Professor  Ignaz 
Dollinger  of  Wiirzburg,  who  in  the  previous  year 
had  published  works  on  the  value  and  significance 
of  comparative  anatomy  and  on  the  development 
of  the  brain  ("  Beitrage  zur  Entwickelungsgeschichte 
des  Gehirns").  Dollinger  was  a  disciple  of  the 
philosopher  Schelling.  At  the  same  time  he  was  a 
keen  observer,  known  to  have  improved  the  micro- 
scope, and  a  skillful  teacher.  Under  his  direction 
von  Baer  pursued  the  study  of  comparative  anat- 
omy for  two  years.  Before  the  expiration  of  that 
time,  Dollinger  having  expressed  the  wish  to  have 


EMBRYOLOGY  AND  VON  BAER    245 

somebody  undertake  a  detailed  study  of  the  devel- 
opment of  the  chick,  Christian  Heinrich  Pander,  a 
friend  of  von  Baer's,  was  induced  to  come  to  Wiirz- 
burg  and  devote  himself  to  the  investigation. 

In  1817  Pander  set  forth  the  results  of  his  research 
in  a  Latin  thesis,  which  before  the  end  of  the  year 
appeared  in  a  German  translation,  "Beitrage  zur 
Entwickelungsgeschichte  des  Hiihnchens  im  Ei." 
It  was  illustrated  by  sixteen  excellent  copperplate 
engravings,  the  work  of  the  anatomist  and  archaeolo- 
gist E.  J.  D'Alton.  Pander  describes  the  formation, 
within  the  first  twenty-four  hours  of  incubation,  of 
the  three  layers  of  what  he  was  the  first  to  name  the 
"  blastoderm."  All  subsequent  development  is  noth- 
ing else  than  "a  metamorphosis  of  this  membrane, 
endowed  with  an  inexhaustible  supply  of  creative 
force,  and  of  the  three  layers  that  compose  it."  The 
outer  layer  he  called  the  "serous,"  the  middle  layer 
he  called  the  "vascular,"  and  the  inner,  the  "mu- 
cous." The  metamorphosis  by  which  these  three 
layers  are  transformed  into  the  various  organs  and 
systems  of  the  body  is  more  precisely  described  by 
Pander,  then  a  young  man  of  twenty-four,  than  it 
had  been  by  Wolff,  whose  theory  and  observations 
he  in  the  main  confirmed.  In  fact,  it  was  not  till  the 
appearance  of  Pander's  dissertation  that  students  of 
embryonic  development  found  the  clue  to  the  de- 
scriptions and  the  generalizations  of  his  eighteenth 
century  predecessor. 


246    THE  HISTORY  OF  MEDICINE 

Von  Baer,  in  the  meantime,  after  spending  a  few 
months  in  Berlin,  had  gone  to  Konigsberg  as  pro- 
sector to  Professor  K.  F.  Burdach,  under  whom  he 
had  studied  at  Dorpat.  He  was  appointed  professor 
of  zootomy  in  1819.  In  the  same  year,  stimulated 
by  the  results  of  Pander's  investigation,  he  began 
his  special  studies  in  embryology,  which  he  pursued 
with  intense  energy  for  the  subsequent  seven  years. 
In  1827  he  began  to  publish  statements  of  the  re- 
sults of  his  researches.  He  had  discovered  as  present 
in  all  vertebrate  animals  the  notochord,  the  key,  as 
Sedgwick  has  called  it,  to  the  whole  of  vertebrate 
morphology.  He  sprang  into  special  prominence  by 
the  announcement  of  the  discovery  of  the  mam- 
malian ovum  —  "Epistola  de  ovi  mammalium  et 
hominis  genesi."  He  had  verified  the  conjecture  of 
Prevost  and  Dumas  by  finding  the  human  ovum  in 
a  Graafian  follicle.  This  capital  discovery  gave  a 
new  meaning  to  Harvey's  dictum,  omne  vivum  ex 
ovot  confirmed  man's  place  in  relation  to  the  lower 
animals,  and  established  human  embryology  as  a 
branch  of  general  biology.  Some  of  von  Baer's  more 
general  results  appeared,  also  in  1827,  in  Burdach's 
"  Physiologie,"  which  contained,  in  addition,  con- 
tributions on  the  development  of  invertebrates  by 
Professor  Rathke,  and  on  the  Entozoa  in  particular 
by  the  youthful  K.  T.  E.  von  Siebold. 

In  1828  appeared  the  first  volume  of  the  work 


EMBRYOLOGY  AND  VON  BAER    247 

which  established  the  fame  of  Karl  Ernst  von  Baer 
as  the  greatest  embryologist  of  the  nineteenth  cen- 
tury— "Ueber  die  Entwickelungsgeschichte  der 
Thiere  —  Beobachtung  und  Reflexion."  The  title  is 
doubly  significant,  in  the  first  place  as  indicating 
the  beginning  of  comparative  embryology,  in  the 
second  place  as  indicating  von  Baer's  unique  com- 
bination of  accurate  observation  and  unerring  pow- 
ers of  generalization.  Following  up  the  results  of  his 
friend  Pander,  to  whom  the  book  was  dedicated, 
von  Baer  traced  carefully  the  development  of  the 
chick  day  by  day,  and  at  the  same  time  took  ac- 
count of  other  embryos.  He  recognized  two  chief 
layers  in  the  blastoderm,  the  animal  and  the  vege- 
tative, Pander's  vascular  layer  consisting,  in  von 
Baer's  judgment,  of  derivatives  from  the  so-called 
serous  and  mucous  layers.  These  layers  were  in  no 
sense  ordinary  tissues,  but  true  germinal  layers,  the 
source  of  all  the  systems  and  organs  of  the  body. 
From  the  animal  layer  come  the  external  skin,  the 
sense  organs,  and  the  nervous  system  in  general; 
from  its  derivative  the  muscular  and  osseous  sys- 
tems. From  the  vegetative  layer  come  the  internal 
lining  of  the  alimentary  canal  and  all  its  dependen- 
cies —  salivary  glands,  lungs,  liver,  etc. ;  while  from 
its  derivative  come  the  heart,  blood-vessels,  kid- 
neys, spleen,  sexual  glands,  etc.  The  germ-layers, 
observed  in  the  embryos  of  all  species  of  animals 


248    THE  HISTORY  OF  MEDICINE 

except  the  very  lowest,  produce  the  fundamental 
systems  by  forming  tubular  cavities,  from  which  the 
special  parts  and  organs  are  in  turn  evolved.  The 
formation  of  the  central  nervous  system  by  the  fold- 
ing of  the  outer  germ-layer  is  an  example  familiar 
to  all.  As  far  as  the  development  of  the  alimentary 
canal  is  concerned  Wolff  had  anticipated  the  ob- 
servations of  von  Baer.  In  a  similar  way  the  walls 
of  the  body  and  the  bony  skeleton  arise  from  mus- 
cular and  osseous  tubes. 

By  1834  von  Baer  had  added  through  continued 
research  to  his  data  concerning  the  development  of 
animals.  His  publisher  pressed  him  to  complete  the 
material  for  a  second  volume,  and  finally,  having 
waited  in  vain,  proceeded  to  publication  in  1837 
without  receiving  the  consent  of  the  author.  Von 
Baer  in  1835  contributed  a  paper  on  the  embryology 
of  fishes — "Untersuchungen  iiber  die  Entwicke- 
lungsgeschichte  der  Fische" — and  put  on  record 
the  observation  of  the  segmentation  of  the  yolk  in 
the  ovum  of  the  fish.  The  remainder  of  his  long  life 
was,  however,  given  up  to  other  scientific  interests. 
As  early  as  1827  he  had  been  invited  to  the  Academy 
of  Sciences  at  St.  Petersburg;  he  had  gone  to  the 
Russian  capital  to  live  in  1829,  only  to  return  to 
Konigsberg  the  following  year.  But  in  1834  ne  took 
up  permanent  residence  in  his  native  country  as 
zoological  member  of  the  St.  Petersburg  Academy. 


EMBRYOLOGY  AND  VON  BAER    249 

Von  Baer  traveled  extensively,  sometimes  at  the 
instance  of  the  Russian  government,  sometimes  at 
the  dictate  of  his  scientific  curiosity.  He  visited 
North  Cape,  Nova  Zembla,  the  Volga,  the  Caspian 
Sea,  the  Sea  of  Azov.  He  was  interested  in  the 
physical  features  of  the  country,  in  its  resources, 
especially  in  its  fisheries,  and  in  the  distribution  of 
plants  and  animals.  He  had  early  written  on  the 
subject  of  fossils.  In  1845  he  published  a  paper  on 
teratology.  In  1858-61  he  visited  the  museums  of 
London  and  other  European  cities.  He  made  a 
special  study  of  anthropology,  particularly  crani- 
ology,  and  in  1861,  in  conjunction  with  another 
embryologist,  Rudolf  Wagner,  called  together  the 
first  Congress  of  Anthropologists.  One  is  impelled 
to  ask  whether  after  1834  von  Baer  felt  that  fur- 
ther progress  in  embryology  must  depend  on  a  fun- 
damental reconstruction  of  biological  conceptions. 
In  1862  he  resigned  his  position  as  an  active  mem- 
ber of  the  Russian  imperial  Academy.  A  few  years 
later  he  wrote  his  Autobiography  at  the  suggestion 
of  his  admirers  among  the  Baltic  nobility,  and  on 
November  28,  1876,  he  died  at  Dorpat  in  his  eighty- 
fifth  year. 

Von  Baer's  special  training  and  his  opportunities 
for  comprehensive  observation  would  seem  an  al- 
most ideal  preparation  for  the  appreciation,  if  not 
indeed  the  discovery,  of  the  doctrine  of  organic 


250     THE  HISTORY  OF  MEDICINE 

evolution.  On  the  basis  of  his  embryological  studies 
he  sought  to  classify  animals  under  certain  types, 
between  which  he  recognized  a  distant  kinship.  In 
fact,  according  to  von  Baer,  for  one  brief  moment  in 
the  course  of  embryonic  development  there  is  a 
degree  of  conformity  between  vertebrate  and  in- 
vertebrate animals.  The  further  we  go  back  in  de- 
velopment, he  says,  the  more  we  find  agreement  in 
animals  of  very  different  sorts.  We  are  thus  led  to 
ask,  he  continues,  whether  in  the  beginning  of  de- 
velopment all  animals  are  not  essentially  alike,  and 
whether  there  is  not  for  all  a  common  original  form. 
It  need  not,  however,  greatly  surprise  us  to  find 
that  von  Baer  raised  his  voice  in  opposition  to  the 
teachings  of  Charles  Darwin  ("Reden  und  kleine 
Aufsatze,"  1864-77).  In  this  respect  he  may  be 
compared  with  Sir  Richard  Owen,  from  whom  Dar- 
win and  his  friends  hoped  to  gain  support  for  their 
doctrines.  The  severest  critics  of  a  new  theory  are 
not  unlikely  to  be  men  who  have  long  cherished 
views  only  slightly  dissimilar  to  those  they  feel 
called  upon  to  discuss,  and  who  thus  bring  to  the 
discussion  a  special  knowledge  of  the  data  and  a 
keen  sense  of  the  danger  of  the  generalizations  in- 
volved. 

Professor  Locy,  referring  to  the  period  in  the 
history  of  embryology  between  the  work  of  von 
Baer  and  that  of  Francis  Balfour  states  that  there 


:  P  7  0  F 
EMBRYOLOGY  AND  VON  BAER    251 

were  great  general  advances  in  the  knowledge  of 
organic  structure  that  brought  the  whole  process  of 
development  into  a  new  light.  "Among  the  most 
important  advances,"  he  continues,  "are  to  be 
enumerated  the  announcement  of  the  cell-theory, 
the  discovery  of  protoplasm,  the  beginning  of  the 
recognition  of  germinal  continuity,  and  the  estab- 
lishment of  the  doctrine  of  organic  evolution."  In 
a  passage  dealing  with  the  last  item  in  this  enumera- 
tion the  same  author  says:  "The  general  acceptance 
of  the  doctrine,  which  followed  after  fierce  opposi- 
tion, had,  of  course,  a  profound  influence  on  embry- 
ology. The  latter  science  is  so  intimately  concerned 
with  the  genealogy  of  animals  and  plants,  that  the 
newly  accepted  doctrine,  as  affording  an  explana- 
tion of  this  genealogy,  was  the  thing  most  needed." 
These  great  advances  in  the  knowledge  of  organic 
structure  were  all  made  before  the  death  of  von 
Baer.  At  the  same  time  there  was  a  marked  im- 
provement of  the  technique  of  investigation,  and,  of 
course,  a  steady  accumulation  of  results.  The  princi- 
ples set  forth  by  J.  J.  Lister  in  a  paper  read  before 
the  Royal  Society  in  the  beginning  of  1830  led  to  a 
much-needed  improvement  of  the  microscope  both 
in  England  and  on  the  continent  of  Europe.  About 
1855  von  Gerlach  made  use  of  carmine  as  a  nuclear 
stain,  and  before  1876  Golgi  had  introduced  the  use 
of  silver  nitrate  in  the  study  of  the  nervous  system. 


252    THE  HISTORY  OF  MEDICINE 

A  further  improvement  in  technique  came  through 
the  introduction  of  the  microtome  in  the  prepara- 
tion of  histological  sections  by  Purkinje,  by  Lister, 
and  by  Wilhelm  His,  famous  for  his  study  of  the 
development  of  nervous  tissue. 

Among  the  contributions  to  embryology  before 
the  discovery  of  the  cell-theory  mention  should  be 
made  of  the  work  of  von  Baer's  colleague  at  Konigs- 
berg,  Martin  Heinrich  Rathke,  who  observed  the 
branchial  clefts  and  the  visceral  arches  in  the  em- 
bryos of  abranchiate  animals,  and  by  the  applica- 
tion of  the  germ-layer  doctrine  in  the  investigation 
of  lower  species  established  his  claim  to  be  called  the 
founder  of  invertebrate  embryology.  Von  Siebold 
has  already  been  associated  with  him.  Herold's 
early  study  of  the  embryonic  development  of  spiders 
should  not  be  overlooked  in  this  connection.  Von 
Baer's  discovery  of  the  mammalian  ovum,  as  his 
confirmation  of  the  germ-layer  doctrine,  stimulated 
a  series  of  special  studies.  As  early  as  1825  Purkinje 
had  described  the  germinal  vesicle  in  the  ovum  of 
the  bird.  In  1833  Coste  reported  the  discovery  of 
the  germinal  vesicle  in  the  mammalian  ovum,  and  a 
year  or  two  later  Wagner  discovered  the  germinal 
spot.  Bischoff,  early  interested  in  human  embryol- 
ogy, ultimately  traced  the  development  of  the  ovum 
in  four  species  of  mammals,  namely,  the  rabbit,  dog, 
guinea-pig,  and  deer. 


EMBRYOLOGY  AND  VON  BAER    253 

Johannes  M tiller  contributed  to  the  progress  of 
embryology  personally  and  through  the  work  of  his 
pupils.  In  1829-30  he  investigated  the  development 
of  the  genito-urinary  organs,  and  the  name  Miil- 
lerian  duct  is  still  applied  to  the  duct  of  the  pro- 
nephros,  which  in  the  adult  becomes  converted  into 
the  genital  passages.  Muller's  "Handbook  of 
Physiology"  by  its  statement  of  the  results  of  in- 
vestigations in  embryology  helped  (along  with  the 
books  of  Wagner  and  Valentin)  to  make  the  teach- 
ings of  that  branch  of  biological  science  widely 
known.  We  must  defer  till  the  next  chapter  the  con- 
sideration of  the  work  of  two  of  Muller's  most  dis- 
tinguished pupils,  Schwann  and  Virchow.  A  third 
pupil,  Reichert,  by  his  volume  "Histology  and 
Embryology,"  brought  to  bear  on  the  study  of  em- 
bryonic development  the  method  and  point  of  view 
suggested  by  the  formulation  in  the  preceding  year 
(1839)  of  the  cell-theory.  In  1837  he  had  made  a 
special  study  of  the  transformation  of  the  visceral 
arches.  The  work  of  Reichert  was  followed  by  that 
of  a  fourth  pupil  of  Muller's,  von  Kolliker,  who  in 
1841  explained  the  cellular  origin  of  the  sperma- 
tozoa, their  nature  and  function.  In  1843  he  pub- 
lished a  paper  on  the  development  of  invertebrates, 
and  in  1861  he  wrote  the  first  book  on  comparative 
embryology.  Robert  Remak,  also  a  pupil  of  Jo- 
hannes Muller's,  in  a  study  of  the  chick  and  frog, 


254    THE  HISTORY  OF  MEDICINE 

1851-55,  reviewed  and  clarified  the  origin  of  the 
germ-layers  from  the  blastoderm,  and  indicated  to 
some  extent  their  relation  to  the  formation  of  the 
body  cavities.  A  few  years  before  (1849),  Huxley 
had  put  forward  the  view  that  the  ectoderm  and  the 
endoderm  of  the  Ccelenterata  are  analogous  to  the 
serous  and  mucous  germ-layers  observed  by  Pander 
in  the  development  of  the  chick. 

A  few  examples  must  suffice  to  show  the  nature  of 
some  of  the  advances  made  in  embryology  between 
the  appearance  of  Darwin's/ 'Origin  of  Species"  and 
the  death  of  von  Baer.  In  1861  Gegenbaur  showed 
that  the  vertebrate  ovum  consists  of  a  single  cell, 
and  in  1865  he  turned  his  attention  with  like  results 
to  the  examination  of  the  spermatozoon.  That  the 
embryo  is  formed  from  these  unicellular  elements 
and  that  development  takes  place  through  cell- 
division  became  the  natural  presuppositions  of  sub- 
sequent theories  of  heredity.  The  study  of  Amphi- 
oxus  by  Kowalevsky  in  1866  tended  to  break  down 
the  sharp  distinction  that  had  been  made  between 
the  vertebrates  and  the  invertebrates,  and  his  doc- 
trine that  all  animals  pass  through  a  gastrula  stage 
—  a  doctrine  elaborated  by  Haeckel  —  went  further 
toward  establishing  the  unity  of  the  development 
of  all  organisms.  At  about  the  same  time,  Fritz 
M tiller,  one  of  the  earliest  German  converts  to  the 
teachings  of  Darwin,  gave  a  new  formulation  to  the 


EMBRYOLOGY  AND  VON  BAER    255 

theory  of  recapitulation,  to  which  reference  has  al- 
ready been  made,  and  which  assumes  that  all  animals 
of  complex  structure  are  the  descendants  of  simpler 
forms.  In  1874  another  disciple  of  Darwin's,  Francis 
Maitland  Balfour,  who  had  pursued  some  of  his  in- 
quiries at  the  newly  established  Zoological  Station 
at  Naples,  made  report  before  the  British  Asso- 
ciation at  Belfast  of  some  of  those  investigations 
which  culminated  in  his  volumes  on  Comparative 
Embryology  (1879-81).  And  in  1875  Oscar  Hertwig, 
known  to  the  twentieth  century  as  the  author  of  a 
monumental  work  on  vertebrate  embryology  (1901, 
et  seq.\  published  his  discoveries  concerning  the  pro- 
cess of  fertilization. 

In  his  lecture  on  "Embryology  and  Medical 
Progress"  Charles  Sedgwick  Minot  says:  "Embry- 
ology supplies  facts  which  are  directly  valuable  to 
the  practitioner.  It  supplies  explanations  and  in- 
terpretations of  many  anatomical  structures  and 
relations  which  would  otherwise  remain  incompre- 
hensible. It  supplies  the  clues  to  many  common  and 
rare  anomalies,  and  it  supplies  to  pathology  a  series 
of  fundamental  conceptions,  without  which  our 
actual  present  pathological  knowledge  could  not 
have  been  upbuilt.  These  claims  of  embryology  to 
recognition  are  very  great,  but  nevertheless  they  do 
not  include  her  greatest  claim  to  a  preeminent  place 
among  the  medical  sciences.  That  greatest  claim  is 


256    THE  HISTORY  OF  MEDICINE 

established  in  my  opinion  by  the  contribution  of 
embryology  to  the  solution  of  the  problem  of  or- 
ganic structure." 

REFERENCES 

Haeckel,  Ernst:  Evolution  of  Man. 

Locy,   W.  A.:   "Malpighi   in    Embryology,"   Popular    Science 

Monthly,  1905,  vol.  67,  pp.  97-126. 
Minot,  C.  S.:    "Embryology  and  Medical  Progress,"  Popular 

Science  Monthly,  1906,  vol.  69,  pp.  5-20. 
Wheeler,  W.  M.:  Caspar  Friedrich  Wolff  and  the  Theoria  Genera- 

tionis,  Woods  Roll  Biological  Lectures,  1898,  pp.  265-84. 
Whitman,  C.  O.:   Bonnet's  Theory  of  Evolution,  and  Evolution 

and  Epigenesis,  Woods  Holl  Biological  Lectures,  1894,  pp. 

225-40,  pp.  205-24. 


CHAPTER  XIII 

THE  CELL-THEORY  AND  CELLULAR 
PATHOLOGY 

THE  cell-theory  resulted  from  the  investigations  of 
the  botanist  Schleiden  and  the  anatomist  and 
physiologist  Schwann.  It  teaches  that  the  tissues  of 
developing  plants  and  animals  are  composed  of  cells, 
and  it  may  be  compared  with  earlier  attempts  to 
discover  a  morphological  unit  in  the  organism,  such 
as  Haller's  theory  of  fibers,  Milne  Edward's  theory 
of  globules,  or  Bichat's  doctrine  of  elementary  tis- 
sues. Cells  had  been  observed  by  microscopists  as 
early  as  the  seventeenth  century,  notably  by  Robert 
Hooke  (1665),  who  examined  sections  of  cork  under 
his  compound  microscope,  and  found  them  made  up 
of  little  boxes  or  cells.  He  described  the  sections  as 
"all  cellular  or  porous  in  the  manner  of  a  honey- 
comb, but  not  so  regular."  His  drawings  of  these 
cork  cells  were  reproduced  in  his  book  "Micro- 
graphia,"  one  of  the  very  early  publications  of  the 
Royal  Society.  The  observations  made  at  this  time 
by  means  of  the  microscope  seemed  to  confirm 
speculations  concerning  atoms  and  pores  which  had 
persisted  among  medical  philosophers  from  the  time 
of  Democritus.  In  the  eighteenth  century  Wolff,  as 


258    THE  HISTORY  OF  MEDICINE 

already  implied,  recognized  common  elements  in  the 
minute  structure  of  developing  plants  and  animals. 
Huxley  gives  the  following  statement  of  Wolff's 
views:  "Every  organ,  he  says,  is  composed  at  first 
of  a  little  mass  of  clear,  viscous,  nutritive  fluid, 
which  possesses  no  organization  of  any  kind,  but  is 
at  most  composed  of  globules.  In  this  semifluid 
mass  cavities  (Blaschen,  Zellen)  are  now  developed ; 
these,  if  they  remain  round  or  polygonal,  become 
the  subsequent  cells;  if  they  elongate,  the  vessels; 
and  the  process  is  identically  the  same,  whether  it  is 
examined  in  the  vegetating  point  of  a  plant,  or  in 
the  young  budding  organs  of  an  animal." 

Mathias  Jakob  Schleiden  (1804-81)  was  inter- 
ested in  the  development  of  plants,  their  anatomy 
and  physiology,  rather  than  in  their  classification 
under  barbarous  Latin  names.  He  studied  the  rela- 
tion of  the  cell-nucleus,  which  had  been  discovered 
by  Robert  Brown  in  1831,  to  the  development  of  the 
cell.  Moreover,  he  attained  to  the  view  that  the  cell 
is  the  elementary  organ  of  the  plant.  The  develop- 
ment of  plant  tissues  depends  on  the  nucleated  cell. 
For  Schleiden  the  development  of  the  cells  of  plants 
was  a  matter  of  supreme  interest.  His  treatment  of 
this  question  appeared  under  the  title  "  Ueber  Phyto- 
genesis"  in  Miiller's  "Archiv"  (1838). 

Theodor  Schwann  (1810-82)  was  a  pupil  of 
Johannes  M tiller  at  Bonn,  and  later  (1834-38)  at 


THE  CELL-THEORY  259 

Berlin.  Besides  the  formulation  of  the  cell-theory  a 
long  list  of  triumphs  stands  to  his  credit,  including 
the  discovery  of  the  sheath  of  the  axis-cylinder  of 
nerves,  and  the  recognition  of  the  organic  nature  of 
yeast  and  its  r61e  in  fermentation.  In  1837  Schleiden 
told  Schwann  of  his  observations  of  the  nuclei  of 
plant  cells.  Schwann  had  himself  noted  (under 
Miiller's  direction)  the  nucleated  cells  of  the  noto- 
chord.  The  two  friends  compared  the  results  of 
their  investigations,  and  Schleiden  recognized  in 
Schwann's  sections  of  the  notochord  nucleated  cells 
similar  to  those  he  had  himself  observed  in  plants. 
Subsequently  Schwann  included  in  his  investiga- 
tion the  cellular  origin  and  development  of  various 
tissues,  and  arrived  at  the  generalization  that 
"There  is  one  universal  principle  of  development 
for  the  elementary  parts  of  organisms,  however 
different,  and  that  principle  is  the  formation  of 
cells."  In  1839  appeared  his  "Microscopical  Re- 
searches concerning  the  Harmony  in  Structure  and 
Growth  of  Animals  and  Plants."  In  this  work  he 
says:  "The  development  of  the  proposition  that 
there  exists  one  general  principle  for  the  formation 
of  all  organic  productions,  and  that  this  principle  is 
the  formation  of  cells,  as  well  as  the  conclusions 
which  may  be  drawn  from  this  proposition,  may  be 
comprised  under  the  term  cell-theory." 

The  views  of  biologists  concerning  the  nature  and 


260    THE  HISTORY  OF  MEDICINE 

origin  of  cells  were  soon  modified  by  further  dis- 
coveries. In  1835  Dujardin  had  observed  a  semi- 
fluid, jelly-like  substance  in  protozoa,  endowed  with 
all  the  qualities  of  life.  The  term  "protoplasm"  was 
first  used  by  Purkinje  in  1839,  to  designate  the 
germinal  ground-substance  of  the  embryo.  In  1846 
von  Mohl  observed  a  jelly-like  substance  in  plants 
to  which  he  applied  the  name  "protoplasma."  A 
few  years  later  Cohn  noted  the  similarity,  if  not 
identity,  of  animal  and  plant  protoplasm.  In  1852 
Remak  established  the  fact  that  it  is  by  cell-divi- 
sion that  the  tissues  develop  from  the  three  embry- 
onic layers.  Two  years  later  Virchow  was  making 
the  cell-theory  the  basis  of  his  system  of  pathology. 
Rudolf  Virchow  (1821-1902)  was  born  in  Pome- 
rania,  began  the  study  of  medicine  at  Berlin  in  the 
year  in  which  Schwann's  Microscopical  Researches 
appeared,  and  received  his  degree  during  the  dean- 
ship  of  Johannes  Miiller,  who  was  his  model  and 
ideal.  In  the  following  year  he  was  demonstrator  of 
anatomy  at  the  Charite  Hospital  (Berlin).  Here  he 
had  special  charge  of  chemical  and  histological  inves- 
tigations, and  his  work  in  microscopic  pathological 
anatomy  suggested  to  his  mind  the  need  of  studying 
the  relationship  between  pathology  and  physiology. 
In  1847  he  established  the  "Archiv"  (fiir  pathol- 
ogische  Anatomic  und  Physiologic  und  fiir  klinische 
Medizin")  since  known  by  his  name.  About  the 


THE  CELL-THEORY  261 

same  time  he  was  appointed  by  the  Prussian  govern- 
ment to  investigate  an  epidemic  of  typhus  fever 
in  Upper  Silesia.  His  report  not  only  recommended 
certain  hygienic  measures  but  took  the  government 
to  task  for  the  deplorable  social  conditions  in  that 
province,  and  advocated  complete  and  unlimited 
democracy,  and  "  education,  with  her  two  daughters, 
freedom  and  prosperity."  He  was  already  showing 
the  personal  spirit  and  political  tendencies  that 
later  made  him  the  vigorous  opponent  of  Bismarck. 
Some  years  later  he  wrote:  "  I  uphold  my  own  rights, 
and  therefore  I  also  recognize  the  rights  of  others. 
This  is  the  principle  I  act  upon  in  life,  in  politics  and 
in  science.  We  owe  it  to  ourselves  to  defend  our 
rights,  for  it  is  the  only  guarantee  for  our  individual 
development,  and  for  our  influence  upon  the  com- 
munity at  large."  From  the  summer  of  1848,  the 
year  of  the  attempted  revolution  in  Prussia,  till  the 
summer  of  the  year  following  he  published  a  weekly 
on  Medical  Reform,  which  ultimately  had  a  great 
effect  on  the  sanitation  of  Berlin.  But  the  govern- 
ment could  not  tolerate  his  activity  as  an  agitator. 
His  pay  was  suspended  for  a  time  in  the  spring  of 
1849,  and  Virchow  took  advantage  of  a  call  to  Wiirz- 
burg  to  withdraw  from  Prussian  territory.  At  the 
University  of  Wurzburg  he  was  closely  associated 
with  von  Kolliker,  who  had  treated  the  segmenta- 
tion of  the  egg,  and,  as  we  have  seen,  other  phases 
of  embryonic  development. 


262    THE  HISTORY  OF  MEDICINE 

In  1854  Virchow  began  to  edit  a  six- volume 
"Handbuch  der  speciellen  Pathologic  und  Thera- 
pie."  In  the  first  volume  he  states  that  there  is  no 
essential  difference  between  physiological  and  path- 
ological laws.  The  human  body,  like  all  organisms, 
is  composed  of  minute  elements,  each  of  which  can 
be  ultimately  traced  to  a  single  cell  and  its  sphere  of 
influence.  These  organic  cellular  elements  and  ele- 
mentary precincts  are  anatomically  recognizable. 
They  are  at  the  same  time  morphological  and  vital 
units,  differing  from  inorganic  matter  both  in  their 
composition  and  in  their  power  to  reproduce  them- 
selves. It  would  be  a  mistake,  however,  to  regard 
the  body  as  a  mere  aggregation  of  these  vital  units. 
They  are  parts  of  a  higher  unity.  Some  would  de- 
scribe this  higher  unity  as  a  vital  principle  or  con- 
structive vital  spirit,  which  in  consistency  they  are 
bound  to  postulate  in  plants  as  well  as  in  animals. 
According  to  Virchow  the  expression  "constructive 
vital  spirit"  is  purely  figurative,  like  the  expression 
"  Landesvater  "  as  applied  to  a  monarch.  The  unity 
of  the  living  body  consists  only  in  the  interdepend- 
ence of  its  living  elements.  The  harmonious  inter- 
action of  these  elements,  all  derived  originally  from 
one  simple  element,  is  the  condition  of  life.  "Life 
does  not  proceed  discontinuously,  or  by  fits  and 
starts,  but  in  the  regular,  legitimate  succession  of 
generations."  Pathological  derangement  must,  to 


THE  CELL-THEORY  263 

begin  with,  involve  definite  elements.  Every  dis- 
ease has  therefore  a  local,  anatomical  starting  point 
or  seat. 

In  1856  Virchow  was  recalled  to  Berlin  as  pro- 
fessor of  pathology  and  director  of  a  new  Pathologi- 
cal Institute.  In  1858  he  gave  a  series  of  twenty 
lectures  to  members  of  the  medical  profession. 
These  were  published  under  the  title  "Cellular 
Pathology  as  Based  upon  Physiological  and  Patho- 
logical Histology."  After  pointing  to  the  advances 
in  medicine  which  in  the  past  had  followed  the  work 
of  the  Alexandrian  anatomists,  of  Vesalius,  and  of 
Bichat,  who  developed  the  principles  of  general 
anatomy,  Virchow  says:  "What  Schwann,  however, 
has  done  for  histology,  has  as  yet  been  but  in  a  very 
slight  degree  built  up  and  developed  for  pathology, 
and  it  may  be  said  that  nothing  has  penetrated  less 
deeply  into  the  minds  of  all  than  the  cell-theory  in 
its  intimate  connection  with  pathology."  In  a  rela- 
tively short  time  Bichat  came  to  exercise  an  extraor- 
dinary influence  on  the  state  of  medical  opinion.  The 
hesitancy  to  build  upon  the  discoveries  of  Schwann 
was  owing,  according  to  Virchow,  to  the  continued 
incompleteness  of  knowledge  in  the  medical  pro- 
fession of  the  intimate  structure  of  the  tissues. 
Particular  difficulty  had  been  found  in  deciding 
which  parts  of  the  body  are  the  source  of  action  — 
what  parts  are  active,  what  passive.  "The  chief 


264    THE  HISTORY  OF  MEDICINE 

point  in  this  application  of  histology  to  pathology  13 
to  obtain  a  recognition  of  the  fact  that  the  cell  is  the 
ultimate  morphological  element  in  which  there  is 
any  manifestation  of  life,  and  that  we  must  not 
transfer  the  seat  of  real  action  to  any  point  beyond 
the  cell." 

At  the  same  time  the  idea  of  the  cell  was  in  need  of 
restatement.  Hooke  and  other  early  observers  were 
inclined  to  magnify  the  importance  of  the  cell-wall 
and  to  minify  the  importance  of  the  cell-contents. 
Indeed,  the  very  name  "cell"  tended  to  fix  upon  the 
enclosing  membrane  as  the  characteristic  feature. 
Virchow  held  that  Schwann  in  his  observations  had 
been  unduly  influenced  by  the  botanist  Schleiden. 
Schleiden  was  particularly  prone  to  exaggerate  the 
importance  of  the  cell-wall  because  he  thought  that 
the  nucleus  never  lay  free  in  the  interior  of  the  cell 
but  was  always  enclosed  in  the  cell- wall.  The  typical 
plant  cell  was  thought  to  consist  of  an  extraneous 
membrane  of  cellulose,  generally  found  to  be  desti- 
tute of  nitrogen,  and  nitrogenized  contents  differing 
from  it.  To  this  type  of  plant  cell  the  cartilage  cell 
with  its  capsule  seemed  to  be  comparable,  but  the 
capsule  is  not  an  essential  part  of  the  cartilage  cell ; 
it  is  really  the  result  of  excretion,  and  in  the  young 
cell  may  be  observed  to  be  very  thin.  Virchow  came 
to  the  general  conclusion  that  when  we  separate 
from  the  cell  all  that  has  been  added  to  it  by  an 


THE  CELL-THEORY  265 

after-development,  "we  obtain  a  simple,  homo- 
geneous, extremely  monotonous  structure,  recurring 
with  extraordinary  constancy  in  living  organisms. 
But  just  this  very  constancy  forms  the  best  cri- 
terion of  our  having  before  us  in  this  structure  one 
of  those  really  elementary  bodies,  to  be  built  up  of 
which  is  eminently  characteristic  of  every  living 
thing  —  without  the  pre-existence  of  which  no  liv- 
ing forms  arise,  and  to  which  the  continuance  and 
maintenance  of  life  is  intimately  attached." 

In  this  opening  lecture  of  the  series  Virchow  also 
restated  his  view  of  1854  m  reference  to  the  relation 
of  cell  to  cell  within  the  organism,  making  more  ex- 
plicit the  analogy  between  the  cells  in  the  body  and 
the  citizens  in  the  State.  The  highly  developed 
organism,  whether  plant  or  animal,  must  be  re- 
garded as  made  up  of  a  larger  or  smaller  number  of 
similar  or  dissimilar  cells.  Every  animal  is  a  sum  of 
vital  elements,  each  of  which  manifests  all  the  char- 
acteristics of  life.  Life  cannot  be  especially  attrib- 
uted to  one  particular  seat  or  organ,  such  as  the 
brain  of  man,  but  it  must  be  recognized  in  each  in- 
dividual cell,  the  constantly  recurring  structure,  or 
morphological  and  vital  unit.  "Hence  it  follows 
that  the  structural  composition  of  a  body  of  con- 
siderable size,  a  so-called  individual,  always  repre- 
sents a  kind  of  social  arrangement  of  parts,  an  ar- 
rangement of  a  social  kind,  in  which  a  number  of 


266    THE  HISTORY  OF  MEDICINE 

individual  existences  are  mutally  dependent,  but  in 
such  a  way,  that  every  element  has  its  own  special 
action,  and,  even  though  it  derive  its  stimulus  to 
activity  from  other  parts,  yet  alone  effects  the 
actual  performance  of  its  duties." 

In  his  second  lecture  on  "Cellular  Pathology" 
Virchow  enunciated  what  Lord  Lister  has  described 
as  the  true  and  fertile  doctrine  that  every  morbid 
structure  consists  of  cells  which  have  been  derived 
from  pre-existing  cells  as  a  progeny.  His  earlier 
study  of  parasitic  organisms  had  not  converted  him 
to  a  belief  in  spontaneous  generation.  In  the  first 
volume  of  the  "Handbook  of  Special  Pathology  and 
Therapeutics,"  already  referred  to,  he  had  written  a 
section  on  plant  and  animal  parasites.  We  are  in- 
debted to  him  for  the  first  good  descriptions  of  some 
of  the  nonbacterial  fungus  infections  (mycoses) ;  and 
this  volume  of  1854  gives  a  list  of  thirty  metazoan 
parasites,  classified  as  trematodes,  cestodes,  nema- 
todes,  etc.  In  this  list  are  found  the  Tcenia  solium, 
Trichina  spiralis  (to  which  Virchow  at  a  later  date 
directed  his  attention  to  the  great  benefit  of  the 
public  health),  Ancylostoma  duodenale,  Filaria  medi- 
nensis,  as  well  as  the  parasitic  causes  of  hepatic 
distomiasis,  and  of  bilharziasis.  In  1858  he  was  pre- 
pared to  maintain  that  even  in  pathology  no  devel- 
opment of  any  kind  begins  de  novo,  and  that  the 
theory  of  spontaneous  generation  is  to  be  rejected 


THE  CELL-THEORY  267 

just  as  decisively  in  the  history  of  individual  parts 
as  in  that  of  entire  organisms.  A  tsenia  solium  does 
not  owe  its  origin  to  the  intestinal  mucus  nor  a 
fungus  take  its  life  from  decomposing  animal  or 
vegetable  matter;  "equally  little  are  we  disposed 
to  concede  either  in  physiological  or  pathological 
histology,  that  a  cell  can  build  itself  up  out  of  non- 
cellular  substance.  Where  a  cell  arises,  there  a  cell 
must  have  previously  existed  (omnis  cellula  e  cell- 
ula),  just  as  an  animal  can  spring  only  from  an 
animal,  a  plant  only  from  a  plant.  In  this  manner, 
although  there  are  still  a  few  spots  in  the  body  where 
absolute  demonstration  has  not  yet  been  afforded, 
the  principle  is  nevertheless  established,  that  in  the 
whole  series  of  living  things,  whether  they  be  entire 
plant  or  animal  organisms,  or  essential  constituents 
of  the  same,  an  eternal  law  of  continuous  develop- 
ment prevails.  There  is  no  discontinuity  of  develop- 
ment of  such  a  kind  that  a  new  generation  can  of 
itself  give  rise  to  a  new  series  of  developmental 
forms.  No  developed  tissues  can  be  traced  back 
either  to  any  large  or  small  simple  element,  unless 
it  be  to  a  cell."  This  clear  statement  of  the  law  of 
the  genetic  continuity  of  cells  was  based  of  course  in 
part  on  the  studies  of  von  Kolliker,  Remak,  and 
other  embryologists. 

Karl  Blind  is  the  authority  for  an  anecdote  in- 
tended to  throw  light  on  Virchow's  view  of  his  own 


268    THE  HISTORY  OF  MEDICINE 

contribution  to  the  development  of  the  cell- theory. 
At  a  party  given  in  honor  of  Virchow  on  the  eve  of 
his  departure  for  Cambridge,  where  he  was  to  give 
an  address  at  a  Harvey  celebration,  Blind  broached 
the  question  of  Harvey's  claim  to  be  the  first  dis- 
coverer of  the  circulation  of  the  blood.  Professor 
Hecker  of  Berlin  had  given  proofs  of  the  worthless- 
ness  of  Harvey's  claims  in  the  early  part  of  the  nine- 
teenth century,  and  Blind  himself  had  found  addi- 
tional evidence  in  the  writings  of  Leonardo  da  Vinci. 
Virchow  in  a  conversation  lasting  nearly  half  an 
hour  made  eager  attempts  to  convince  Blind  of  his 
mistake,  and  finally  observed  (according  to  Blind) : 
"It  might  as  well  be  contended,  and  it  has  even 
been  contended,  that  the  cellular  theory  was  not  my 
own."  This  remark  seemed,  to  the  narrator  of  the 
story,  directed  against  those  who  had  pointed  out 
the  claims  of  Schleiden  and  Schwann.  Blind's  own 
judgment  was  that  Virchow  had  worked  out  a 
cellular  theory  of  his  own,  correcting  the  mistakes  of 
his  predecessors,  and  giving  a  demonstration  of  his 
aphorism,  Omnis  cellula  e  cellula. 

The  pathology  of  Morgagni  was  a  pathology  of 
the  organs;  that  of  Bichat  a  pathology  of  the  tissues 
composing  the  organs;  cellular  pathology  in  turn 
fixed  attention  on  the  elements  that  go  to  the  forma- 
tion of  the  tissues.  Naturally  the  cell-theory  en- 
abled Virchow  to  review  the  work  of  Bichat,  and  to 


THE  CELL-THEORY  269 

make  a  more  thorough  analysis  of  the  components 
of  the  various  organs  and  systems.  As  constituting 
one  class  of  normal  tissues  he  recognized  those  com- 
posed exclusively  of  cells.  Of  this  class  the  epithelial 
formations  are  typical  —  the  epidermis,  the  rete 
Malpighi,  the  nails,  the  crystalline  lens,  the  mucous 
and  serous  membranes,  and  the  active  elements  of 
the  glands,  which,  Remak  showed,  owe  their  origin 
to  the  proliferation  of  epithelial  structures.  A  sec- 
ond class  of  normal  tissues  includes  those  in  which 
the  cellular  elements  are  separated  by  a  certain 
amount  of  intercellular  matter.  To  this  class  belong 
those  to  which  Johannes  Miiller  gave  the  name 
"connective  tissues."  (In  the  earlier  medical  litera- 
ture they  had  been  called  "cellular,"  that  is, 
"areolar";  which  indicates  very  definitely  how 
the  term  "cell"  had  shifted  its  meaning.)  To 
Virchow's  third  class  belong  the  highly  specialized 
tissues,  under  which  class  come  the  nervous  and 
muscular  systems,  the  vessels  and  the  blood.  In 
considering  the  physiology  and  pathology  of  the 
brain,  we  must  take  into  account  not  only  its 
nervous  tissue,  but  its  membranes,  vessels,  and  in- 
terstitial substance.  (We  owe  to  Virchow  the  term 
"neuroglia,"  as  well  as  "mycosis,"  "embolism," 
" arthritis  deformans,"  "heterotopia,"  etc.).  Simi- 
larly a  long  bone  is  to  be  regarded  as  an  organ  con- 
sisting of  at  least  three  tissues  besides  the  osseous. 


270    THE  HISTORY  OF  MEDICINE 

Do  the  general  types  established  for  the  physio- 
logical tissues  hold  good  for  the  pathological?  Yes, 
every  pathological  structure  has  its  physiological 
prototype.  At  times  the  new  formation  (neoplasm) 
corresponds  to  the  type  of  tissue  in  which  it  occurs 
as  a  pathological  phenomenon,  as  when  a  fatty 
tumor  develops  in  adipose  tissue.  The  neoplasm  is 
then  said  to  be  homologous.  In  contrast  with 
homology  heterolbgy  is  the  occurrence  of  a'  new 
formation  in  a  type  of  tissue  from  which  it  differs, 
as,  for  example,  in  fatty  degeneration  of  muscular 
tissue,  or  amyloid  degeneration  of  the  kidneys. 
Pathological  conditions  may  arise  not  only  from  the 
misplacing  of  tissues  (heterotopia)  but  also  from 
their  retarded  or  premature  development  (hetero- 
chronia),  as,  for  example,  when  bone  is  invaded  by 
a  cartilaginous  tumor,  and,  lastly,  from  the  mere 
variation  of  their  quantity  (heterometria).  Under 
heterometria  is  included  hyperplasia,  involving  an 
increase  in  the  number  of  the  cells.  Hypertrophy 
may  result  merely  from  the  enlargement  of  the  in- 
dividual cells,  as,  for  example,  in  the  enlargement  of 
the  hepatic  cells  in  hypertrophy  of  the  liver.  Patho- 
logical states  may  be  caused  also  by  intracellular 
changes. 

Virchow  included  in  his  "Cellular  Pathology" 
the  consideration  of  the  diseases  of  the  blood  and  the 
blood-vessels.  He  describes  the  minute  crystals  of 


THE  CELL-THEORY  271 

haematoidin,  discovered  by  him,  and  mentions  their 
occurrence  in  the  cicatrix  following  cerebral  haemor- 
rhage. Leukaemia,  first  observed  and  named  in 
1845,  is  here  spoken  of  as  "a  permanent,  progressive 
leucocytosis."  Virchow  distinguishes  it  from  pyae- 
mia, notes  the  hsemorrhagic  tendency  associated 
with  it,  and  connects  it  causally  with  the  lymphatic 
glands  and  the  spleen.  Chlorosis,  which  usually  in- 
volves imperfect  development  of  the  aorta,  and 
frequently  of  the  heart  and  sexual  organs,  is  not  to 
be  confused  with  leukaemia.  Perhaps,  however, 
Virchow's  greatest  individual  triumph  in  pathology 
was  his  doctrine  of  embolism,  and  the  consequent 
clearing-up  of  the  nature  of  thrombosis  and  phlebi- 
tis. Setting  aside  the  speculations  of  the  French 
pathologist  Cruveilhier  (1791-1873),  with  whom  the 
idea  of  phlebitis  had  become  almost  an  obsession, 
Virchow  inquires  in  reference  to  the  facts  concerning 
the  composition  and  the  origin  of  the  thrombus. 
Microscopic  examination  reveals  that  the  coagu- 
lated mass  consists  of  broken-down  cells,  of  dis- 
integrated fibrin,  and  of  white  and  red  blood- 
corpuscles  undergoing  disorganization,  and,  in  the 
case  of  the  last-named,  in  process  of  discoloration. 
Though  it  may  look  like  pus,  it  should  never  be 
regarded  as  pus.  The  pathological  condition  begins 
with  the  coagulation,  the  formation  of  the  thrombus 
in  the  blood.  Virchow  readily  admits  that  at  times 


272    THE  HISTORY  OF  MEDICINE 

phlebitis,  as  well  as  arteritis  and  endocarditis,  may 
give  rise  to  thrombosis;  but  real  phlebitis  is  an  in- 
flammation of  the  walls,  and  not  of  the  contents  of 
the  vein.  Moreover,  he  finds  that  not  infrequently 
the  small  branches  of  the  peripheral  veins  become 
quite  filled  with  masses  of  coagulum.  The  greater 
number  of  these  thrombi  become  prolonged  beyond 
the  mouths  of  the  branches,  and  greatly  enlarged. 
From  these  prolonged  thrombi  particles  (emboli) 
are  carried  along  by  the  blood  stream.  Minute 
fragments  may  hence  be  wedged  tightly  into  the 
nearest  system  of  arteries  or  capillaries.  "Thus  we 
see  that  as  a  rule  all  the  thrombi  of  the  periphery  of 
the  body  produce  secondary  obstructions  and  meta- 
static  deposits  in  the  lungs."  It  is  also  noted  that 
embolism  in  certain  cases  occasions  sudden  occlu- 
sions of  the  vessels  of  the  eye  or  brain. 

To  Johannes  M  tiller,  who  had  laid  down  the  law 
of  the  correspondence  between  embryonic  and 
pathological  development,  Virchow  owed  no  doubt 
some  of  his  interest  in  the  pathology  of  the  fcetus, 
in  what  he  called  "agenesia"  (aplasia  cerebri),  as 
well  as  in  allied  subjects,  such  as  the  structure  of  the 
umbilical  cord,  and  tubal  pregnancy.  Miiller's  his- 
tological  study  of  tumors  exerted  a  no  less  decisive 
influence  on  Virchow's  uncompleted  work  of  three 
volumes,  "Die  Krankhaften  Geschwiilste"  (1863- 
67),  one  of  his  greatest  contributions  to  pathology. 


THE  CELL-THEORY  273 

In  this  work  is  maintained  the  point  of  view  of  the 
Cellular  Pathology.  It  must  be  ever  realized,  said 
Virchow,  that  tumors,  whether  they  are  parasitic  in 
origin  or  not,  are  always  portions  of  the  body,  and 
do  not  develop  from  some  morbid  humor  of  the 
organism,  nor  independently  through  some  special 
force  of  their  own  substance.  He  held  that  tumors 
owe  their  origin  as  a  rule  to  the  less  highly  special- 
ized tissues,  to  the  connective  tissue,  and,  more 
particularly,  the  epithelial.  At  one  time  he  was 
inclined  to  trace  the  derivation  of  cancers  to  the 
mesoblast,  but,  probably  influenced  by  investi- 
gators who  thought  these  growths  were  also  of 
epithelial  origin,  he  left  this  part  of  his  work  unfin- 
ished. He  gave  the  first  description  of  hematoma 
of  the  dura  mater,  and  of  glioma. 

Virchow  was  also  the  first  to  describe  leontiasis 
ossea;  he  discovered  the  lymphatic  sheaths  of  the 
cerebral  arteries ;  in  his  doctor's  thesis  he  treated  the 
topic  of  the  inflammation  of  the  cornea  (keratitis), 
and  noted  that  wounds  of  the  cornea  repair  without 
the  presence  of  plastic  exudations;  he  maintained 
that  Peyer's  patches  are  only  lymphatic  glands,  and 
that  in  disease  they  play  a  part  comparable  with 
that  of  axillary  and  inguinal  glands;  he  set  forth  in 
detail  the  pathology  of  syphilis;  he  investigated 
tuberculosis,  and  established  the  relation  to  it  of 
lupus;  and  he  explained  the  forms  of  parenchymat- 


274    THE  HISTORY  OF  MEDICINE 

ous  inflammation.  Virchow  was  not  disdainful  of 
therapeutics,  and  his  attitude  in  this  regard  may 
have  influenced  his  student  Hoppe-Seyler,  and 
others  closely  associated  with  him.  He  is  also  men- 
tioned in  connection  with  the  investigation  of  septi- 
caemia, leprosy,  cholera,  smallpox,  diphtheria,  pella- 
gra, the  pearly  disease  of  cattle,  Addison's  disease, 
exophthalmic  goitre,  and  cretinism.  He  was  inter- 
ested in  the  composition  of  adipocire.  He  was  active 
in  municipal,  as  well  as  national  politics,  and  in- 
stituted in  Berlin  a  system  of  sewage  disposal  and 
other  sanitary  reforms.  In  what  was  named,  by 
him,  the  "Kulturkampf,"  he  considered  himself  the 
champion  of  liberal  culture  against  the  forces  of 
obscurantism.  On  the  eve  of  the  Franco-Prussian 
War  he  stood  as  the  advocate  of  European  disarma- 
ment, but  during  the  conflict  he  took  a  very  promi- 
nent part  in  the  organization  of  the  ambulance  and 
hospital  service.  He  also  contributed  to  the  im- 
provement of  civil  hospitals  and  of  nursing.  Along 
with  his  varied  pursuits  he  made  extensive  collec- 
tions, labeling  over  twenty-three  thousand  speci- 
mens, which  he  presented  to  the  Pathological  Mu- 
seum. 

In  the  judgment  of  Virchow  medicine  as  an  ap- 
plied science  must  rest  on  the  firm  basis  of  the 
natural  sciences.  At  the  same  time  he  looked  upon 
the  classical  literatures  as  the  source  of  European 


THE  CELL-THEORY  275 

culture.  He  encouraged  the  archaeological  researches 
of  Schliemann,  and  in  1879  was  with  him  in  the 
Troas,  and,  nine  years  later,  in  Egypt,  Nubia,  and 
the  Peloponnesus.  Like  von  Baer  he  devoted  a 
great  deal  of  energy  to  the  study  of  anthropology, 
particularly  craniology.  He  followed  the  genetic 
method  of  seeking  the  explanation  of  things  in  their 
origins.  He  applied  that  method  to  the  study  of 
medicine.  "For  me,"  he  said,  "medicine  does  not 
begin  to-day,  and  I  hold  it  impossible  to  be  com- 
pletely at  home  in  it,  if  one  does  not  interpret  it 
genetically."  He  was  the  first  to  write  on  the  rela- 
tion of  medicine  to  the  fine  arts.  Perhaps  it  was  his 
sense  of  historical  perspective  that  made  him  con- 
temptuous of  the  trace  of  humoral  pathology  that 
survived  in  the  teachings  of  the  great  Viennese 
pathologist  Rokitansky,  and  made  him  at  the  same 
time  distrustful  of  the  doctrines  of  Darwin,  of  Koch 
and  von  Behring. 

REFERENCES 

Blind,  Karl:  "Personal  Recollections  of  Virchow,"  North  Ameri- 
can Review,  1920,  vol.  175,  pp.  613-24. 

Geddes,  Patrick:   "Protoplasm,"  Encyclopaedia  Britannica. 

Israel,  Oscar:  Rudolf  Virchow,  Annual  Report,  Smithsonian 
Institution,  1901-02,  pt.  I,  vol.  57,  pp.  641-59. 

Tyson,  James.   The  Cell-Doctrine.   1878. 

Virchow,  Rudolf:  Cellular  Pathology  as  Based  upon  Physiological 
and  Pathological  Histology  (translated  by  Frank  Chance). 

Wilson,  E.  B.:   The  Cell  in  Development  and  Inheritance.    1896. 


CHAPTER  XIV 
THE  INTRODUCTION  OF  ANAESTHETICS 

THE  title  of  Priestley's  work,  "Experiments  and 
Observations  on  Different  Kinds  of  Air"  (1774,  et 
seq.),  gives  some  indication  of  how  little  was  known 
concerning  the  chemistry  of  gases  in  the  latter  part 
of  the  eighteenth  century.  The  composition  of  the 
atmosphere  had  remained  undetermined;  marsh 
gas,  carbon  dioxide,  as  well  as  oxygen,  nitrogen,  and 
hydrogen,  were  kinds  of  air.  The  names  by  which 
we  know  them  had  to  wait  upon  their  differentia- 
tion, upon  their  analysis,  or  upon  the  analysis  of  the 
compounds  of  which  they  formed  parts,  such  as 
water,  nitric  acid  and  other  acids.  A  great  step  for- 
ward was  made  when,  on  August  I,  1774,  Priestley 
in  an  apparatus  from  which  air  was  excluded  ignited 
litharge  by  means  of  a  burning-glass.  He  tested  the 
factitious  air  thus  obtained  by  placing  in  it  a  piece 
of  lighted  charcoal.  In  the  belief  that  the  supporter 
of  combustion  is  also  the  supporter  of  life  he  put  two 
mice  into  the  newly  isolated  gas.  He  then  inhaled 
some  of  the  gas,  and  observed  an  exhilarating  effect. 
"Who  can  tell,"  he  writes,  "but  in  time  this  pure 
air  may  become  a  fashionable  article  in  luxury? 


ANESTHETICS  277 

Hitherto  only  two  mice  and  myself  have  had  the 
privilege  of  breathing  it." 

Before  the  end  of  the  century  the  investigations 
of  Priestley,  Scheele,  and  others  inspired  Dr. 
Thomas  Beddoes  to  found  in  one  of  the  suburbs  of 
Bristol  the  Pneumatic  Institution  to  carry  on  ex- 
periments, and  to  treat  patients  by  means  of  the 
newly  discovered  factitious  airs.  This  enterprise 
has  been  described  as  a  scientific  aberration,  but 
Beddoes  was  fortunate  in  choosing  as  an  assistant 
to  superintend  the  experiments  Humphry  Davy, 
then  (1798)  nineteen  years  old.  Davy  experimented 
for  months  with  nitrous  oxide,  which  had  been  dis- 
covered some  time  previously  and  which  in  1793 
was  produced  by  heating  ammonium  nitrate;  that 
is,  the  process  still  in  use  to-day.  The  fact  that  it 
supports  combustion  like  pure  oxygen  may  have 
directed  special  attention  to  it,  but  it  had  been 
declared  poisonous,  and  had  even  been  described 
as  the  "principle  of  contagion."  Davy,  however, 
finally  ventured  on  the  crucial  experiment  of  in- 
haling large  quantities  of  the  gas.  After  being  sub- 
jected to  nitrous  oxide  in  an  air-tight  chamber  for  an 
hour  and  a  quarter  he  inhaled  twenty  quarts  of  the 
pure  gas. 

"A  thrilling,"  he  says,  in  describing  the  experi- 
ence, "extending  from  the  chest  to  the  extremities, 
was  almost  immediately  produced.  I  felt  a  sense  of 


278     THE  HISTORY  OF  MEDICINE 

tangible  extension  highly  pleasurable  in  every  limb; 
my  visible  impressions  were  dazzling,  and  appar- 
ently magnified;  I  heard  every  sound  in  the  room, 
and  was  perfectly  aware  of  my  situation.  By  de- 
grees, as  the  pleasurable  sensations  increased,  I  lost 
all  connection  with  external  things;  trains  of  vivid 
visible  images  rapidly  passed  through  my  mind,  and 
were  connected  with  words  in  such  a  manner,  as  to 
produce  perceptions  perfectly  novel.  I  existed  in  a 
world  of  newly  connected  and  newly  modified  ideas: 
I  theorized,  I  imagined  that  I  made  discoveries. 
When  I  was  awakened  from  this  semi-delirious 
trance  by  Dr.  Kinglake,  who  took  the  bag  from  my 
mouth,  indignation  and  pride  were  the  first  feelings 
produced  by  the  sight  of  the  persons  about  me.  My 
emotions  were  enthusiastic  and  sublime,  and  for  a 
minute  I  walked  round  the  room  perfectly  regard- 
less of  what  was  said  to  me.  As  I  recovered  my 
former  state  of  mind,  I  felt  an  inclination  to  com- 
municate the  discoveries  I  had  made  during  the  ex- 
periment. I  endeavored  to  recall  the  ideas:  they 
were  feeble  and  indistinct;  one  collection  of  terms, 
however,  presented  itself;  and  with  the  most  in- 
tense belief  and  prophetic  manner,  I  exclaimed  to 
Dr.  Kinglake,  '  Nothing  exists  but  thoughts!  The  uni- 
verse is  composed  of  impressions,  ideas,  pleasures  and 
pains!11' 

The  discovery  of  the  properties  of  "laughing  gas " 


ANESTHETICS  279 

appealed  to  the  popular  imagination,  and  inhaling 
nitrous  oxide  became  a  regular  form  of  entertain- 
ment. Davy,  made  famous  by  this  and  other  bril- 
liant discoveries,  was  appointed  assistant  lecturer 
in  chemistry  at  the  Royal  Institution,  London, 
where  his  youth,  scientific  acumen,  and  wonderful 
powers  of  expression  soon  drew  upon  him  the  atten- 
tion of  the  fashionable  world.  In  1800,  the  year 
preceding  his  appointment  at  London,  there  ap- 
peared his  "Researches,  Chemical  and  Philosophi- 
cal, chiefly  concerning  Nitrous  Oxide,"  which  sets 
forth  the  following  conclusion:  "As  nitrous  oxide  in 
its  extensive  operation  appears  capable  of  destroy- 
ing physical  pain,  it  may  probably  be  used  with 
advantage  during  surgical  operations  in  which  no 
great  effusion  of  blood  takes  place."  Davy's  sugges- 
tion led  to  no  immediate  effects  in  the  practice  of 
surgery.  Between  the  years  1820  and  1828  Hick- 
man,  a  young  surgeon  of  Shropshire,  England,  ex- 
cruciated by  the  sufferings  of  those  upon  whom  he 
was  called  to  operate,  carried  on  a  series  of  experi- 
ments on  animals  in  order  to  discover  a  method  of 
inducing  insensibility  to  pain  by  means  of  inhala- 
tions. His  early  experiments  were  concerned  with 
the  study  of  asphyxiation,  animals  being  rendered 
unconscious  by  enclosing  them  hi  glass  and  pre- 
venting the  access  of  air  or  by  exposing  them  to 
carbon  dioxide  prepared  from  calcium  carbonate 


280    THE  HISTORY  OF  MEDICINE 

and  sulphuric  acid.  Rebuffed  by  the  profession  in 
his  own  country,  he  succeeded  in  1828  in  having  his 
methods  of  producing  anaesthesia  investigated  by 
the  Academy  of  Medicine  in  Paris.  He  failed  to 
gain  the  approbation  of  that  body,  though  there  is 
evidence  that  by  that  time  he  was  using  nitrous 
oxide  and  that  his  claims  were  supported  to  some 
extent  by  the  distinguished  army-surgeon  Baron 
Larrey.  Ethyl  ether  was  destined  to  be  employed 
before  nitrous  oxide  in  surgical  operations. 

Ethyl  ether  had  been  described  as  a  preparation 
before  the  middle  of  the  sixteenth  century.  As  an 
inhalation  it  was  used  in  Birmingham,  England,  as 
early  as  1785,  in  the  treatment  of  asthma  and  other 
respiratory  affections.  Dr.  John  Collins  Warren,  of 
Boston,  Massachusetts,  employed  it  in  1805  in  the 
treatment  of  the  advanced  stages  of  phthisis.  In 
1818  there  appeared  a  brief  article  in  the  "Journal 
of  Science  and  the  Arts,"  London,  containing  the 
following  statement:  "When  the  vapour  of  ether 
mixed  with  common  air  is  inhaled,  it  produces  effects 
very  similar  to  those  occasioned  by  nitrous  oxide." 
It  had  already  evidently  been  considered  a  source 
of  fun,  for  the  writer,  after  describing  the  method 
of  inhalation  and  the  effects,  gives  expression  to  a 
warning,  one  gentleman  after  inhaling  a  large  quan- 
tity having  been  thrown  into  a  "lethargic  state, 
which  continued  with  occasional  periods  of  inter- 


ANESTHETICS  281 

mission  for  more  than  thirty  hours."  This  brief 
article,  or  note,  was  probably  written  by  the  cele- 
brated chemist  Michael  Faraday,  then  a  young  man 
of  twenty-seven  acting  as  Davy's  assistant  at  the 
Royal  Institution. 

In  spite  of  the  warning  concerning  its  imprudent 
use,  ethyl  ether,  like  nitrous  oxide,  continued  to 
furnish  entertainment  both  in  England  and  in  the 
United  States  (where  the  anaesthetic  effects  of  ether 
inhalation  were  soon  recognized  by  Godman  (1822) 
and  other  physicians).  In  1839  at  an  "ether  frolic" 
at  Anderson,  South  Carolina,  a  colored  boy,  who 
had  been  forced  to  inhale  a  considerable  amount  of 
ether,  after  remaining  unconscious  for  an  hour, 
showed  no  subsequent  ill  effects.  This  may  have 
encouraged  the  others.  At  all  events,  one  of  the 
young  men  present  on  that  occasion  became  in  1842 
a  pupil  of  Dr.  C.  W.  Long,  of  Jefferson,  Georgia, 
and  here  the  sport  of  inhaling  ether  was  maintained. 
Dr.  Long  observed  that  he  and  the  others  did  not 
experience  pain  from  any  blows  and  bruises  they 
received  while  under  the  influence  of  the  intoxicant. 
This  led  him  to  think  it  might  be  of  value  in  surgery, 
and  on  March  30,  1842,  he  administered  ether  to 
James  Venable  and  removed  a  small  tumor  from  the 
patient's  neck.  Venable,  the  first  person  to  undergo 
an  operation  under  etherization,  was  somewhat 
addicted  to  inhalation  as  a  pastime,  and  his  bill 


282    THE  HISTORY  OF  MEDICINE 

from  Long,  which  is  still  preserved,  shows  that  ether 
with  operation  cost  two  dollars  and  ether  without 
operation  twenty-five  cents.  Dr.  Long  continued  to 
use  the  anaesthetic  in  his  limited  country  practice; 
but  he  did  not  publish  an  account  of  his  experiences 
with  it,  and  there  is  no  evidence  that  he  exerted  any 
influence  in  bringing  about  the  general  use  of  ether 
in  surgery. 

Two  or  three  years  after  this  occurrence,  an  itiner- 
ant lecturer,  G.  Q.  Colton,  entertained  an  audience 
at  New  Haven,  Connecticut,  by  a  lecture  on 
"Laughing  Gas,"  demonstrating  on  a  few  of  his 
hearers  the  effects  of  inhaling  nitrous  oxide.  A 
young  dentist,  Dr.  Horace  Wells,  who  was  among 
those  present,  made  an  observation  —  similar  to 
Long's  in  the  case  of  ethyl  ether  —  that  those  ex- 
hilarated by  the  inhalation  of  laughing  gas  seem  to 
experience  no  pain  from  even  rather  severe  injuries. 
Impressed  by  this  fact,  and  hoping  to  turn  it  to  ac- 
count in  his  practice,  he  determined  to  submit  him- 
self to  a  decisive  test.  Accordingly,  on  the  day 
following  the  lecture,  Wells  had  one  of  his  own  teeth 
extracted  while  under  the  influence  of  the  anaesthetic 
administered  by  Colton.  He  felt  no  pain.  Hence- 
forth Wells  made  constant  use  of  nitrous  oxide  in  his 
practice  as  a  dentist.  He  foresaw  not  only  the  part 
anaesthesia  was  to  play  in  dentistry,  but  also  its 
value  to  surgery  in  general.  In  the  autumn  of  1845 


ANESTHETICS  283 

he  visited  Boston  in  order  to  direct  the  attention  of 
the  medical  profession  to  the  virtues  of  nitrous 
oxide.  He  seized  an  opportunity  to  give  a  demon- 
stration before  the  Harvard  Medical  College;  but 
on  this  public  occasion  he  failed.  At  this  time  he 
was  thrown  in  contact  with  Dr.  Charles  T.  Jackson 
and  with  William  T.  G.  Morton  (1819-1868).  Wells 
and  Morton  had  been  partners  for  a  short  time  in 
Boston  in  1843.  They  were  both  interested  in  a  new 
method  of  making  false  teeth,  and,  therefore,  had  a 
special  motive  for  discovering  a  means  of  painless 
extraction. 

In  1844  Morton,  without  relinquishing  his  very 
lucrative  practice  as  a  dentist  in  Boston,  had  entered 
the  office  of  Dr.  Jackson  as  a  student  of  medicine, 
and  had  matriculated  at  the  Harvard  Medical  Col- 
lege. In  that  same  year  he  had  begun  to  experiment 
with  ether  as  an  anaesthetic.  He  continued  his  ex- 
periments, both  on  animals  and  human  beings,  in 
the  summer  of  1846.  From  Jackson  he  learned  the 
different  kinds  and  preparations  of  ether,  the  effects 
of  the  inhalations  (as  observed  by  his  preceptor  in 
the  case  of  college  students),  and  the  necessity  of 
making  use  of  ether  free  from  impurities.  Finally 
Morton  had  the  courage  to  try  the  effects  of  ethyl 
ether  inhalation  on  himself,  in  September,  1846. 
He  relates  his  experience  in  the  following  words: 
" I  shut  myself  up  in  my  room;  seated  myself  in  the 


284    THE  HISTORY  OF  MEDICINE 

operating  chair  and  commenced  inhaling.  ...  It 
partially  suffocated  me  but  produced  no  decided 
effect.  I  then  saturated  my  handkerchief  and  in- 
haled it  from  that.  I  looked  at  my  watch  and  soon 
lost  consciousness.  As  I  recovered  I  felt  a  numbness 
in  my  limbs  with  a  sensation  like  a  nightmare  and 
would  have  given  the  world  for  some  one  to  come 
and  arouse  me.  I  thought  for  a  moment  I  should 
die.  ...  At  length  I  felt  a  slight  tingling  of  the 
blood  in  the  end  of  my  third  finger,  and  made 
an  effort  to  touch  it  with  my  thumb,  but  without 
success.  ...  I  pinched  my  thigh,  but  .  .  .  sensation 
was  imperfect.  ...  I  immediately  looked  at  my 
watch.  ...  I  had  been  insensible  between  seven  and 
eight  minutes." 

Before  the  end  of  the  month,  Morton,  with  char- 
acteristic boldness,  made  successful  use  of  ether  in 
extracting  a  tooth.  The  patient  was  given  a  hand- 
kerchief saturated  with  the  anaesthetic,  and  was 
directed  to  inhale.  He  lapsed  into  unconsciousness 
almost  immediately.  A  firmly  rooted  bicuspid  was 
removed,  and  in  about  a  minute  the  patient  re- 
covered consciousness.  This  was  on  September 
3Oth.  Within  less  than  a  week  the  enterprising 
Morton,  then  a  young  man  of  twenty-seven,  called 
on  Dr.  Warren,  senior  surgeon  of  the  Massachu- 
setts General  Hospital,  told  of  his  success,  and 
asked  for  an  opportunity  to  give  a  public  demon- 


ANESTHETICS  285 

stration  of  his  method  of  rendering  insensible  to  pain 
patients  about  to  undergo  surgical  operations.  He 
did  not  have  to  wait  long  for  an  invitation  to  be 
present  at  an  operation,  and  to  put  his  method  to 
the  test. 

At  the  appointed  time,  ten  o'clock  on  the  morning 
of  October  16,  1846,  Morton  was  not  present.  This 
increased  the  skepticism  of  those  assembled  to  wit- 
ness the  test,  and  raised  a  doubt  in  the  minds  of 
some  concerning  the  good  faith  of  the  young  dentist. 
Dr.  Warren,  the  operating  surgeon,  seemed  to  share 
to  some  extent  the  general  feeling  of  incredulity. 
Indeed,  after  waiting  for  a  time,  he  was  about  to 
begin  the  operation  without  Morton's  assistance 
when  the  latter  appeared  on  the  scene.  He  had  been 
delayed  in  securing  some  apparatus  he  thought  de- 
sirable in  administering  the  ether,  namely,  an  in- 
haler provided  with  a  stop-cock  and  fitted  into  a 
glass  vessel  containing  the  ether.  He  now  adjusted 
the  apparatus,  and  in  about  three  minutes  the  pa- 
tient sank  into  a  state  of  insensibility.  The  operator 
made  an  incision  about  three  inches  long  in  the  neck, 
and  proceeded  to  extirpate  a  tumor  just  below  the 
jaw  on  the  left  side.  The  patient,  when  he  recovered 
from  the  effects  of  the  ether,  said  that  he  had  suf- 
fered no  pain  during  the  operation,  though  he  had 
had  the  feeling  that  a  blunt  instrument  was  passing 
roughly  across  his  neck.  Warren,  as  well  as  the 


286    THE  HISTORY  OF  MEDICINE 

others  present,  was  convinced  that  Morton  had 
made  good  his  claim,  though  the  patient  soon  after 
the  first  incision  had  begun  to  speak  incoherently, 
and  had  appeared  to  give  indications  of  suffering, 
his  agitation  continuing  till  the  operation  was  over. 
On  the  following  day  Dr.  Hayward  removed  a 
tumor  from  the  arm  of  a  woman  while  she  was  under 
the  influence  of  the  inhalation.  In  this  case  the 
anaesthetic  was  administered  throughout  the  opera- 
tion, and  the  patient  remained  unconscious  except 
for  a  disagreeable  dream  toward  the  close.  Morton's 
triumph  was  complete. 

The  use  of  ethyl  ether  as  an  anaesthetic  soon 
gained  the  recognition  it  deserved.  Every  success- 
ful operation  under  etherization  increased  the  con- 
fidence of  the  profession  and  strengthened  the  public 
faith  in  Morton's  innovation.  Three  weeks  after  his 
first  success  with  the  anaesthetic,  Dr.  Hayward  am- 
putated a  lower  extremity  above  the  knee,  the  pa- 
tient remaining  unconscious  throughout  the  opera- 
tion. The  prestige  of  the  Massachusetts  General 
Hospital,  and  the  support  of  such  leaders  in  the 
medical  world  as  Warren,  Hayward,  and  Bigelow, 
account  for  the  rapid  headway  of  surgical  anaesthesia 
throughout  all  civilized  countries.  Henry  J.  Bige- 
low, considered  at  that  time  one  of  the  best  surgeons 
in  America,  who  had  been  appointed  to  the  staff  of 
the  Massachusetts  General  Hospital  and  professor 


ANESTHETICS  287 

of  surgery  In  the  Harvard  Medical  College  in  the 
year  of  the  great  discovery,  did  his  utmost  to  en- 
courage Morton.  As  early  as  November  3d  he  read 
a  paper  dealing  with  the  new  anaesthetic  before  the 
Academy  of  Arts  and  Sciences.  He  published  this 
paper  in  the  "  Boston  Medical  and  Surgical  Journal " 
November  i8th.  Three  days  later  Dr.  Oliver  Wen- 
dell Holmes  suggested  the  terms  "anaesthesia"  and 
"anaesthetic"  in  the  sense  in  which  they  are  still 
employed. 

In  the  following  weeks  Bigelow  carried  a  sample 
of  ether  to  London,  arriving  in  that  metropolis 
December  lyth.  Two  days  later  it  was  there  used 
by  a  dentist  in  extracting  a  tooth,  and  on  December 
2  ist  Robert  Liston,  the  famous  surgeon,  employed 
it  in  an  amputation  of  the  thigh.  Syme,  his  cousin 
and  sometime  partner,  used  it  in  his  Edinburgh 
practice  the  following  year.  On  January  19,  1847, 
Simpson,  who  had  discussed  with  Liston  in  the  pre- 
ceding Christmas  holidays  the  use  of  ethyl  ether,  led 
a  notable  advance  by  introducing  the  anaesthetic 
into  the  practice  of  midwifery.  After  several 
months,  referring  to  his  experience  with  ether,  he 
wrote:  "I  have  employed  it  with  few  and  rare  ex- 
ceptions, in  every  case  of  labor  that  I  have  attended ; 
and  with  the  most  delightful  results.  ...  I  have 
never  had  the  pleasure  of  watching  over  a  series  of 
better  or  more  rapid  recoveries;  nor  once  witnessed 


288    THE  HISTORY  OF  MEDICINE 

any  disagreeable  result  follow  to  either  mother  or 
child ;  whilst  I  have  now  seen  an  immense  amount  of 
maternal  pain  and  agony  saved  by  its  employment." 
Among  the  European  apostles  of  surgical  anaesthesia 
must  also  be  mentioned  Pirogoff,  the  illustrious 
Russian  'military  surgeon.  It  seems  almost  incredi- 
ble that  in  the  year  following  the  use  of  ethyl  ether 
for  the  first  time  in  an  American  hospital  he  could 
have  written  his  "Practical  and  Physiological  Re- 
searchesjconcerning  Etherization."  Two  years  later 
appeared  a  medical  report  of  his  experiences  in  the 
Caucasus  containing  interesting  statistics  of  the 
results  of  amputating  under  the  new  conditions. 

On  November  4,  1847,  Professor  (later,  Sir) 
James  Young  Simpson  of  Edinburgh  l  discovered 
the  anaesthetic  effects  of  chloroform  on  human 
beings.  This  compound  had  been  discovered  almost 
simultaneously,  in  1831,  by  Guthrie  in  America, 
Liebig  in  Germany,  and  Soubeiran  in  France.  In 
1834  the  great  French  chemist  J.  B.  Dumas  cor- 
rectly described  its  composition  and  gave  it  the 
designation  "chloroform."  In  the  March  preceding 
Simpson's  discovery,  its  anaesthetic  effects  on  lower 
animals  had  been  recorded  by  the  noted  French 


1  "Chloric  ether" — that  is,  an  alcoholic  solution  of  chloroform  — 
had  been  tried  by  Morton  before  his  success  with  ethyl  ether.  Warren 
had  used  "chloric  ether"  by  preference  after  October  16,  1846.  It 
had  also  been  employed  at  St.  Bartholomew's  Hospital,  London,  in 
the  summer  of  1847. 


ANESTHETICS  289 

physiologist  Flourens.  In  his  search  for  an  anaesthe- 
tic inhalation  less  irritant  than  ethyl  ether,  Simpson 
had  been  advised  to  try  chloroform  ("perchloride 
of  formyle")  by  Waldie,  described  as  a  chemist  of 
Liverpool,  but  born,  like  Simpson  himself,  in  the 
county  of  Linlithgow.  Simpson,  after  examining 
with  the  assistance  of  his  colleagues,  Keith  and  Dun- 
can, a  great  variety  of  chemicals  in  the  hope  of  find- 
ing a  substitute  for  ethyl  ether,  decided  to  put 
chloroform  to  the  test.  The  three  friends  inhaled  it 
one  evening  from  tumblers  in  the  dining-room  of 
Simpson's  home  in  Edinburgh.  They  became  exhila- 
rated, and  the  members  of  the  household  enjoyed 
the  liveliness  of  the  ensuing  conversation.  Then  the 
three  became  suddenly  insensible.  Nothing  daunted, 
however,  by  this  first  experience,  they  inhaled  the 
chloroform  repeatedly  that  same  evening.  Simp- 
son's niece  was  inclined  to  try  it  also.  Folding  her 
arms  across  her  breast  and  inhaling  the  chloroform, 
she  fell  asleep  crying,  "I'm  an  angel!  Oh,  I'm  an 
angel!" 

Within  the  following  week  Simpson  tried  the  new 
anaesthetic  on  upwards  of  thirty  people,  using  it  in 
extracting  teeth,  opening  abscesses,  to  annul  the 
pain  of  dysmenorrhcea,  neuralgia,  etc.  Moreover, 
he  employed  it  with  conspicuous  success  in  obstetric 
practice.  The  lady  to  whom  it  was  first  adminis- 
tered in  child-birth  had  previously  been  delivered 


290    THE  HISTORY  OF  MEDICINE 

in  the  country,  after  prolonged  labor,  only  by  sacri- 
ficing the  life  of  the  child.  In  this,  her  second  con- 
finement, she  was  worn  by  anxiety  and  sleepless- 
ness, and  pains  supervened  a  fortnight  before  full 
time.  Three  hours  and  a  half  after  the  occurrence 
of  the  first  pains,  at  the  beginning  of  the  first  stage 
of  parturition,  she  inhaled  from  a  handkerchief  on 
which  a  teaspoonful  of  chloroform  Had  been  poured. 
Ten  or  twelve  minutes  later  a  like  amount  was  ad- 
ministered, and  the  child  was  born  twenty-five  min- 
utes after  the  beginning  of  the  first  inhalations. 
The  patient  was  not  aroused  by  the  crying  of  the 
child  nor  at  the  coming  away  of  the  placenta.  When 
she  did  regain  consciousness  she  remarked  to  Simp- 
son that  she  had  had  a  very  comfortable  sleep,  that 
she  had  needed  it  having  been  so  tired,  but  that  she 
would  now  be  able  for  the  work  before  her.  Simpson 
made  no  haste  to  set  her  right,  and  when  the  nurse 
came  back  into  the  room  with  the  child,  the  mother 
could  hardly  believe  it  was  her  own  living1  baby,  as 
she  said. 

Before  the  middle  of  November  chloroform  was 
used  as  an  anaesthetic  in  three  operations  at  the 
Royal  Infirmary  of  Edinburgh  in  the  presence  of 
Dumas,  who  chanced  to  be  visiting  Scotland  at  the 
time.  The  notes  of  the  operating  surgeon,  Professor 
Miller,  supply  the  following  account  of  the  first  case. 
"A  boy,  four  or  five  years  old,  with  necrosis  of  one 


ANESTHETICS  291 

of  the  bones  of  the  forearm.  Could  speak  nothing 
but  Gaelic.  No  means,  consequently,  of  explaining 
to  him  what  he  was  required  to  do.  On  holding  a 
handkerchief,  on  which  some  chloroform  had  been 
sprinkled,  to  his  face,  he  became  frightened  and 
wrestled  to  be  away.  He  was  held  gently,  however, 
by  Dr.  Simpson,  and  obliged  to  inhale.  After  a  few 
inspirations  he  ceased  to  cry  or  move,  and  fell  into  a 
sound,  snoring  sleep.  A  deep  incision  was  now  made 
down  to  the  diseased  bone;  and,  by  the  use  of  the 
forceps,  nearly  the  whole  of  the  radius,  in  the  state 
of  sequestrum,  was  extracted.  During  this  opera- 
tion, and  the  subsequent  examination  of  the  wound 
by  the  finger,  not  the  slightest  evidence  of  the  suffer- 
ing of  pain  was  given.  He  still  slept  on  soundly,  and 
was  carried  back  to  his  ward  in  that  state.  Half  an 
hour  afterwards  he  was  found  in  bed,  like  a  child 
newly  awakened  from  a  refreshing  sleep,  with  a 
clear,  merry  eye  and  placid  expression  of  counte- 
nance. .  .  .  On  being  questioned  by  a  Gaelic  inter- 
preter who  was  found  among  the  students,  he  stated 
that  he  had  never  felt  any  pain,  and  that  he  felt 
none  now.  On  being  shown  his  wounded  arm,  he 
looked  much  surprised,  but  neither  cried  nor  other- 
wise expressed  the  slightest  alarm." 

In  the  other  operations  performed  at  the  Royal 
Infirmary  at  this  time  Simpson  made  use  of  a  hollow 
sponge  in  administering  the  anaesthetic.  In  one  of 


292    THE  HISTORY  OF  MEDICINE 

these  cases  —  a  soldier  who  had  an  opening  in  the 
cheek,  the  result  of  exfoliation  of  the  jaw  —  Miller 
recognized  that  it  would  have  been  impossible  to 
employ  any  complicated  inhaling  apparatus  applied 
to  the  mouth  of  the  patient.  In  the  other  case  Dr. 
Duncan  operated  on  a  young  man  suffering  from 
necrosis  of  the  first  phalanx  of  the  great  toe  and 
ulceration  of  the  integuments.  On  November  I5th 
Miller  removed  from  a  private  patient  an  encysted 
tumor  beneath  the  angle  of  the  jaw.  At  that  date 
Simpson  had  administered  chloroform  to  fifty  per- 
sons. 

As  the  acknowledged  champion  of  surgical  anaes- 
thesia he  was  very  successful  in  meeting  the  argu- 
ments and  beating  down  the  prejudices  of  his  oppo- 
nents. Many  of  his  contemporaries  in  Scotland  and 
elsewhere  considered  pain  as  a  punishment  that 
should  be  received  in  a  spirit  of  meekness,  and  the 
resort  to  anaesthetics  seemed  to  them  an  impious 
attempt  to  thwart  the  divine  will,  Simpson  was 
attacked  from  the  pulpit  and  passages  from  the 
Bible  were  quoted  to  prove  the  wickedness  of  his 
undertakings.  But  he  met  arguments  of  this  sort  by 
appealing  to  the  same  authority.  "My  opponents 
forget,"  he  said,  "the  twenty-first  verse  of  the 
second  chapter  of  Genesis ;  it  is  the  record  of  the  first 
surgical  operation  ever  performed,  and  that  text 
proves  that  the  Maker  of  the  universe,  before  he 


ANESTHETICS  293 

took  the  rib  from  Adam's  side  for  the  creation  of 
Eve,  caused  a  deep  sleep  to  fall  upon  Adam."  En- 
lightened clergymen  gave  him  of  course  their  sup- 
port, and  the  opposition  to  the  use  of  anaesthetics  in 
midwifery,  which  had  been  particularly  bitter  — 
pointing  to  the  wickedness  of  trying  to  remove  a 
part  of  the  primal  curse  on  woman  —  broke  down 
when  Queen  Victoria  gave  her  countenance  to  the 
use  of  chloroform  on  the  occasion  of  the  birth  of 
Prince  Leopold  in  1853. 

Anaesthesia  was  not  only,  as  it  has  been  called,  the 
death  of  pain;  it  did  away  to  a  considerable  extent 
with  shock,  and,  by  obviating  the  necessity  of  great 
speed  in  the  performance  of  operations,  made  the 
introduction  of  antiseptic  methods  possible.  Before 
ethyl  ether  and  chloroform  came  into  use  haste  was 
one  of  the  recognized  criteria  of  good  surgery.  One 
reads  of  Cheselden  performing  a  lithotomy  in  less 
than  a  minute;  of  Langenbeck,  surgeon  general  of 
the  Hanoverian  army  in  the  Napoleonic  era,  ampu- 
tating 'a  shoulder  while  one  might  take  a  pinch  of 
snuff;  of  Sir  William  Fergusson,  the  founder  of  con- 
servative surgery,  who  was  at  times  so  speedy  that 
the  onlookers  had  to  keep  on  the  alert  for  fear  of 
missing  the  whole  operation  through  one  moment's 
inattention;  of  Pirogoff,  who  was  so  rapid  and  dex- 
terous in  the  use  of  the  knife  as  to  challenge  com- 
,  parison  with  a  sleight-of-hand  artist.  When,  on 


294    THE  HISTORY  OF,  MEDICINE 

December  21,  1846,  an  anaesthetic  was  first  used  in 
England  in  a  major  operation,  the  surgeon,  Robert 
Liston,  proceeded  as  expeditiously  as  usual,  remov- 
ing the  limb  of  the  patient  at  the  thigh  in  twenty- 
five  'seconds,  according  to  the  statement  of  the 
dresser.  Among  the  onlookers  on  this  occasion  at 
the  University  College  Hospital,  London,  was  a 
young  student  of  nineteen  still  working  for  his  de- 
gree in  arts,  Joseph  Lister,  whose  contributions  to 
surgery  about  twenty  years  later  were  no  less  the 
consequence  of  the  introduction  of  anaesthesia  than 
of  the  development  of  bacteriology. 

Within  those  twenty  years  the  study  of  anaes- 
thetics continued  to  advance.  Ethyl  chloride,  the 
anaesthetic  effects  of  which  on  animals  had  been  re- 
ported by  Flourens  in  1847,  was  tried  in  surgery  in 
1848.  Improved  methods  of  administration  arose 
from  the  work  of  John  Snow  who  invented  an  in- 
haler in  1847  and  published  the  results  of  his  vari- 
ous experiments  in  1858.  His  successor,  J.  T.  Clover, 
invented  his  chloroform  inhaler  in  1862.  This  was 
followed  by  the  Junker  inhaler  in  1867.  Nunneley 
investigated  in  1849,  and  the  years  following,  the 
anaesthetic  properties  of  carbon  dioxide,  ethyl  bro- 
mide, and  other  compounds.  In  1853  Alexander 
Wood  invented  the  hypodermic  syringe  and  thus 
prepared  the  way  for  the  triumphs  of  local  anaes- 
thesia; while  in  1866  Sir  Benjamin  Richardson 


ANESTHETICS  295 

A 

added  to  his  numerous  contributions  to  anaesthesia 
the  use  of  the  ether  spray.  In  1864  a  committee  of 
the  Royal  Medical  and  Chirurgical  Society  recom- 
mended the  mixture  of  alcohol,  chloroform,  and 
ether  first  used  by  Harley.  In  the  years  following 
1863  the  use  of  nitrous  oxide,  which  had  been  al- 
lowed to  lapse  after  the  death  of  Horace  Wells  in 
1848,  was  greatly  stimulated  through  the  advocacy 
of  Colton  both  in  America  and  Europe;  and  in 
1868  Edmund  Andrews  proved  that  the  anaesthetic 
effects  of  nitrous  oxide  do  not  depend  on  partial 
asphyxiation.  He  thus  cleared  up  a  misconception 
of  long  standing.  His  mixture  of  oxygen  and 
nitrous  oxide  gave  very  satisfactory  results. 

REFERENCES 

Bigelow,  Henry  J.:  Surgical  Anaesthesia.  Addresses  and  Other 
Papers.  1900. 

Gordon,  Laing:  Sir  James  Simpson  (Masters  of  Medicine). 
1898.  233  pp. 

Gwathmey,  J.  T.  (in  collaboration  with  Charles  Baskerville) : 
Anesthesia.  1914.  943  pp. 

Kelly,  H.  A.:  "Hypnotism,"  Maryland  Medical  Journal,  vol. 
LIII,  1910,  pp.  81-97. 

Paget,  Sir  James:  "Escape  from  Pain;  the  History  of  a  Dis- 
covery," The  Nineteenth  Century,  vol.  6,  1879,  pp.  1119-32. 

Rice,  Nathan  P.:   Trials  of  a  Public  Benefactor.    1859.   460  pp. 

Young,  Hugh  H.:  Long,  the  Discoverer  of  Anesthesia,  Johns 
Hopkins  Hospital  Bulletin,  vol.  viii,  1897,  pp.  174-84- 


CHAPTER  XV 


WHEN  Charles  Darwin,  in  October,  1836,  returned 
to  England  from  his  voyage  round  the  world,  which 
had  occupied  nearly  five  years,  he  had  arrived  at  no 
theory  concerning  the  origin  of  species.  In  1837, 
however,  he  made  the  following  note:  "In  July 
opened  first  note-book  on  Transmutation  of  Species. 
Had  been  greatly  struck  from  about  the  month  of 
previous  March  on  character  of  South  American 
fossils,  and  species  on  Galapagos  Archipelago. 
These  facts  (especially  latter)  origin  of  all  my 
views."  In  the  months  intervening  between  Octo- 
ber, 1836,  and  July,  1837,  he  had  been  thrown  into 
close  contact  with  the  great  geologist  Sir  Charles 
Lyell,  the  champion  of  the  uniformitarian  doctrine. 
This  doctrine,  that  the  changes  that  have  taken 
place  in  the  earth's  crust  in  the  past  were  owing  to 
agencies  still  in  operation,  had  been  splendidly 
stated  by  the  Scotch  geologist  James  Hutton  in 
1785.  Hutton's  views,  however,  had  been  ignored 
by  some  scientists,  and  decried  by  others  because  of 
their  alleged  anti-religious  tendency.  The  hostility 
to  Hutton's  teaching  in  1822  was  thus  expressed  by 
one  of  the  leading  English  geologists,  who  was  will- 


THEORY  OF  ORGANIC  EVOLUTION  297 

ing  to  concede  some  recognition  to  the  facts  gath- 
ered by  the  Scotch  geologist  in  reference  to  granite 
and  other  rocks:  "The  wild  ness  of  his  theoretical 
views,  however,  went  far  to  counterbalance  the  util- 
ity of  the  additional  facts  which  he  collected  from 
observation.  He  who  could  perceive  in  geology  noth- 
ing but  the  ordinary  operation  of  actual  causes,  car- 
ried on  in  the  same  manner  through  infinite  ages, 
without  the  trace  of  a  beginning  or  the  prospect  of 
an  end,  must  have  surveyed  them  through  the  me- 
dium of  a  preconceived  hypothesis  alone."  Professor 
Sedgwick,  under  whom  Darwin  had  studied  geology 
at  Cambridge,  in  a  similar  vein  eloquently  de- 
nounced the  unscriptural  tenets  of  Hutton  and 
Hutton's  disciples.  Both  Sedgwick  and  Henslow, 
the  botanist,  Darwin's  chief  masters  at  Cambridge, 
were  clergymen,  and  Darwin,  till  the  time  of  his 
appointment  as  naturalist  to  the  Beagle  expedition, 
planned  to  take  orders  ultimately  in  the  Established 
Church  of  England. 

Sir  Charles  Lyell  (1797-1875)  had  been  an  early 
convert  to  the  uniformitarian  view,  but  fully  con- 
scious of  the  strength  of  the  opposition,  and  natur- 
ally kindly  and  sympathetic  as  regards  the  opinions 
of  his  intellectual  inferiors,  his  public  utterances 
were  of  the  most  tactful  sort.  A  careful  study  of 
Gibbon  had  convinced  him  that  the  frontal  attack 
is  not  the  most  effective  method  of  combating  re- 


298    THE  HISTORY  OF  MEDICINE 

ligious  prejudice,  and  had  helped  him  to  develop 
further  a  pleasing  style  of  composition,  which  an 
early  acquaintance  with  the  classics  and  the  con- 
stant example  of  a  father  of  scholarly  tastes  had 
already  made  second  nature.  At  the  age  of  twenty 
he  observed  on  the  coast  of  East  Anglia  the  action 
of  the  sea  in  the  formation  of  new  land  as  well  as  in 
the  wearing  down  of  the  cliffs;  and  in  the  following 
years  he  found  abundant  evidence  in  his  native 
Forfarshire,  in  the  action  of  rain  and  rivers  and  the 
formation  of  limestone,  that  all  observable  changes 
in  the  earth's  crust  were  not  owing  to  the  Noachian 
deluge. 

By  1825  Lyell  was  a  convinced  uniformitarian, 
and  was  considering  how  he  could  express  his  con- 
victions without  rousing  unnecessary  opposition 
and  without  giving  offence  to  his  older  contempo- 
raries. In  1827  he  had  completed  the  first  sketch  of 
his  Principles  of  Geology,  and  two  years  later,  in 
preparing  the  book  for  the  press,  he  made  a  pre- 
liminary statement,  in  a  letter  to  a  friend,  of  his 
doctrine  "that  no  causes  whatever  have  from  the 
earliest  time  to  which  we  can  look  back  to  the  pres- 
ent, ever  acted,  but  those  that  are  now  acting,  and 
that  they  never  acted  with  different  degrees  of 
energy  from  that  which  they  now  exert."  The  first 
volume  appeared  in  1830  with  the  subtitle  "An 
Attempt  to  Explain  the  Former  Changes  of  the 


THEORY  OF  ORGANIC  EVOLUTION  299 

Earth's  Surface  by  Reference  to  Causes  now  in 
Operation."  Lyell  was  not  oblivious  to  the  logical 
outcome  of  applying  the  uniformitarian  doctrine  to 
the  study  of  the  organic  world,  and  when  Sedgwick 
and  others  charged  him  with  holding  that  the  crea- 
tion of  new  species  is  going  on  at  the  present  day  he 
readily  admitted  it.  He  thought  it  impossible  that 
any  one  should  read  his  work  without  perceiving 
that  the  notion  of  uniformity  in  the  existing  causes 
of  change  implies  that  "they  must  for  ever  produce 
an  endless  variety  of  effects,  both  in  the  animate  and 
inanimate  world." 

When  Darwin  was  leaving  England  in  1831  the 
extremely  orthodox  Henslow  advised  him  to  take 
Lyell's  first  volume  with  him,  but  to  pay  no  atten- 
tion to  it,  except  in  regard  to  facts,  for  it  was  alto- 
gether wild  as  far  as  theory  goes.  Needless  to  say  it 
made  a  very  deep  impression  on  the  mind  of  the 
young  naturalist.  Lyell's  second  volume  appeared 
in  1832,  and  a  copy  of  it  was  sent  to  Darwin  at 
Montevideo.  This  second  volume  was  full  of  facts 
concerning  variations,  hybridism,  and  the  struggle 
for  existence;  and  it  no  doubt  had  a  great  effect  on 
Darwin's  subsequent  observations  and  on  his 
maturer  generalizations.  In  fact,  in  dedicating  the 
second  edition  of  "A  Naturalist's  Voyage"  to  Lyell 
the  author  with  characteristic  generosity  writes: 
"This  edition  is  dedicated  with  grateful  pleasure  as 


300    THE  HISTORY  OF  MEDICINE 

an  acknowledgment  that  the  chief  part  of  what- 
ever scientific  merit  this  journal  and  the  other  works 
of  the  author  may  possess,  has  been  derived  from 
studying  the  well-known  and  admirable  '  Principles 
of  Geology."1 

Darwin  was  very  slow  and  systematic  in  arriving 
at  his  generalizations.  Soon  after  he  began  to  col- 
lect data  relating  to  the  transmutation  of  species, 
he  turned  particular  attention  to  the  different  spe- 
cies and  varieties  of  plants  and  animals  under  do- 
mestication, and  to  the  success  of  the  horticulturist 
and  the  breeder  attained  by  a  careful  selection  of 
certain  strains  for  purposes  of  propagation.  Ad- 
mitting that  species  might  arise  in  nature  by  the 
perpetuation  of  chance  variations  he  was  at  a  loss 
to  discover  any  causative  influence  corresponding 
to  what  he  saw  at  work  in  the  improvement  of 
domestic  plants  and  animals.  In  the  autumn  of 
1838  he  read  Malthus's  "Essay  on  Population," 
which  developed  the  teaching  that  it  is  a  constant 
tendency  among  all  living  things  to  increase  more 
rapidly  than  the  means  of  subsistence ;  the  resultant 
disproportion  between  the  two  rates  of  increase  was 
the  occasion  of  wars,  vice,  and  misery.  The  idea 
flashed  into  Darwin's  mind  of  a  natural  selection, 
comparable  in  its  effects  to  the  artificial  selection  he 
had  noted  in  his  study  of  the  improvement  of  culti- 
vated plants  and  domesticated  animals.  Natural 


THEORY  OF  ORGANIC  EVOLUTION  301 

p  r  j  '  /  r  r  ^  r  ' 

selection  might  occur  in  such  hard  conditions  as 
would  cause  organisms  to  compete  with  one  another 
for  their  very  existence.  It  occurred  to  Darwin  that 
under  these  circumstances  ''favorable  variations 
would  tend  to  be  preserved,  and  unfavorable  ones 
to  be  destroyed.  The  result  of  this  would  be  the 
formation  of  new  species.  Here,  then,  I  had  a  theory 
by  which  to  work." 

He  deliberately  refrained  from  making  a  written 
statement  of  his  own  views  till  1842,  when  he  wrote 
out  a  sketch,  which  he  expanded  two  years  later  to 
a  manuscript  of  231  folio  pages.  He  explained  his 
theory  in  a  letter  to  the  American  botanist  Asa 
Gray  in  1857.  He  stated  that  his  belief  that  spe- 
cies have  really  changed  depended  "on  general  facts 
in  the  affinities,  embryology,  rudimentary  organs, 
geological  history,  and  geographical  distribution  of 
organic  beings."  He  maintained  that  if  such  a 
selective  agency  as  has  developed  our  breeds  of 
domestic  animals,  had,  during  the  long  ages  revealed 
by  the  study  of  geology,  exerted  an  influence  on  the 
organic  world  in  general,  it  would  have  produced 
the  miracles  of  design  and  adjustment  in  plants  and 
animals  that  had  hitherto  baffled  his  powers  of  ex- 
planation. Such  an  agency  he  now  finds  in  natural 
selection.  He  mentions  also  the  slowness  of  the 
changes  in  species,  the  struggle  for  life,  and  the 
spontaneous  occurrence  of  favorable  variations. 


302     THE  HISTORY  OF  MEDICINE 

Darwin  had  begun,  in  this  year,  at  the  urgent  re- 
quest of  Lyell,  who  feared  the  new  theory  might  be 
forestalled  by  some  other  naturalist,  the  composition 
of  a  treatise.  When  he  had  written  about  a  half  of 
it,  he  received  a  manuscript  from  Alfred  Russel 
Wallace  setting  forth  a  theory  almost  identical  with 
his  own. 

Wallace's  experience  had  corresponded  in  differ- 
ent respects  with  Darwin's.  He  had  spent  many 
years  in  scientific  exploration  in  South  America  and 
in  the  Malay  Archipelago;  he  had  come  under  the 
influence  of  Lyell ;  he  had  long  considered  the  prob- 
lem of  the  origin  of  species;  and  he  had  finally  been 
led  to  a  solution  by  Malthus's  "Essay  on  Popula- 
tion." He  had  learned  from  the  "Principles  of 
Geology"  that  the  inorganic  world  was  and  always 
had  been  in  a  continual  state  of  slow  modification. 
Consequently  forms  of  life  must  have  become  modi- 
fied and  constantly  adjusted  to  the  new  conditions  in 
order  to  survive.  The  slowness  of  the  changes  re- 
vealed by  the  examination  of  fossils  was  such  as  to 
afford  opportunity  for  the  continuous  automatic 
adjustment  of  organic  beings  to  the  inorganic  en- 
vironment. In  1855  he  arrived  at  the  conclusion 
that  each  species  has  come  into  existence  in  the  same 
environment  as  a  closely  allied  species  and  in  suc- 
cession to  it.  This  indicated  the  fact  of  evolution, 
but  failed  to  explain  the  process.  "In  February, 


THEORY  OF  ORGANIC  EVOLUTION  303 

1858,"  he  writes,  "I  was  suffering  with  a  rather 
severe  attack  of  intermittent  fever  at  Ternate,  in 
the  Moluccas;  and  one  day,  while  lying  on  my  bed 
during  the  cold  fit,  wrapped  in  blankets,  though  the 
thermometer  was  at  88  Fahr.,  the  problem  again 
presented  itself  to  me,  and  led  me  to  think  of  the 
'positive  checks'  described  by  Mai  thus  in  his  '  Essay 
on  Population,'  a  work  I  had  read  several  years 
before,  and  which  had  made  a  deep  and  permanent 
impression  on  my  mind.  These  checks  —  war,  dis- 
ease, famine,  and  the  like  —  must,  it  occurred  to 
me,  act  on  animals  as  well  as  man.  Then  I  thought 
of  the  enormously  rapid  multiplication  of  animals, 
causing  these  checks  to  be  much  more  effective  in 
them  than  in  the  case  of  man;  and  while  pondering 
vaguely  on  this  fact,  there  suddenly  flashed  upon 
me  the  idea  of  the  survival  of  the  fittest  —  that  the 
individuals  removed  by  these  checks  must  be  on  the 
whole  inferior  to  those  that  survived.  In  the  two 
hours  that  elapsed  before  my  ague  fit  was  over,  I 
had  thought  out  almost  the  whole  of  the  theory; 
and  the  same  evening  I  sketched  the  draught  of  my 
paper,  and  in  the  two  succeeding  evenings  wrote  it 
out  in  full,  and  sent  it  by  the  next  post  to  Mr. 
Darwin." . 

In  the  "Origin  of  Species"  (1859),  which  the 
majority  of  scientists  regard  as  exerting  a  greater 
influence  on  the  development  of  ideas  than  any 


304    THE  HISTORY  OF  MEDICINE 

other  book  produced  in  the  nineteenth  century, 
Darwin  turns  his  attention  first  to  the  occurrence  of 
variation  under  domestication.  He  is  not,  as  has 
been  supposed  by  some  of  his  critics,  unaware  of  the 
occasional  occurrence  of  sudden  deviations  from  the 
parental  type,  such  as  in  the  well-known  case  of 
ancon  sheep,  to  which  he  makes  reference.  He  also 
speaks  of  sporting  plants,  and  recognizes  that  a 
seedling  may  exhibit  remarkable  deviation  from 
type.  But  his  main  concern  here  is  with  those  slight 
variations  of  which  the  horticulturist  takes  ad- 
vantage in  the  improvement  of  cultivated  plants, 
and  which  afford  the  material  that  enables  the 
breeder  of  horses,  or  cattle,  or  dogs  to  produce  such 
distinct  types  of  domestic  animals.  He  was  re- 
luctantly inclined  to  believe  that  all  the  different 
breeds  of  horses  were  derived  from  one  wild  stock. 
Domestic  dogs  on  the  other  hand  he  thought  had 
probably  descended  from  several  wild  species, 
though  one  could  not  think  that  a  parent  type  at  all 
resembling  the  Italian  greyhound,  the  Blenheim 
spaniel,  the  bull-dog,  the  bloodhound,  etc.,  had 
ever  existed  freely  in  a  state  of  nature.  Many  of  the 
remarkable  breeds  and  varieties  are  of  course  under- 
going constant  modification  through  a  purposeful 
process  of  artificial  selection. 

Darwin  made  a  particularly  close  study  of  the 
breeds  and  sub-breeds  of  pigeons,  keeping  every 


THEORY  OF  ORGANIC  EVOLUTION  305 

breed  he  could  purchase  or  otherwise  obtain,  secur- 
ing specimens  of  skins  from  India  and  Persia,  con- 
sulting eminent  pigeon-fanciers,  and  noting  the 
references  to  domestic  pigeons  in  the  ancient  litera- 
tures. He  was  convinced  that  the  English  carrier, 
the  tumbler,  the  runt,  the  barb,  the  pouter,  the 
turbit,  the  Jacobin,  the  trumpeter,  the  laugher,  the 
fan  tail,  etc.,  all  draw  their  descent  from  the  rock- 
pigeon  (Columba  livia).  When  two  birds  belonging 
to  two  distinct  domestic  breeds  are  crossed  the 
mongrel  offspring  are  liable  to  show  the  character- 
istic color  and  markings  of  the  ancestral  rock-pigeon. 
"I  crossed,"  writes  Darwin,  "some  uniformly  white 
fantails  with  some  uniformly  black  barbs,  and  they 
produced  mottled  brown  and  black  birds;  these  I 
again  crossed  together,  and  one  grandchild  of  the 
pure  white  fantail  and  pure  black  barb  was  of  as 
beautiful  a  blue  colour,  with  the  white  rump,  double 
black  wing-bar,  and  barred  and  white-edged  tail- 
feathers,  as  any  wild  rock-pigeon ! "  In  spite  of  their 
common  ancestry  the  breeds  are  so  different  among 
themselves  that  an  ornithologist  seeing  them  for  the 
first  time  would  describe  them  as  belonging  to 
well-defined  species,  the  differentiation  depending 
not  only  on  their  general  appearance,  but  on  the 
character  of  their  voice  and  disposition,  on  the 
shape  and  size  of  their  eggs,  and  on  their  anatomical 
structure,  for  example,  the  shape  of  the  skull,  the 


306    THE  HISTORY  OF  MEDICINE 

number  of  the  ribs,  and  the  number  of  the  caudal 
and  sacral  vertebrae.  How  have  these  differences 
been  established?  By  accumulative  artificial  selec- 
tion, the  pigeon-fancier  retaining  for  breeding  pur- 
poses the  birds  that  showed  certain  desirable  char- 
acteristics. "Some  variations  useful  to  him  have 
probably  arisen  suddenly,  or  by  one  step."  But  in 
general  the  variations  put  at  the  disposal  of  man's 
choice  have  been  limited  in  range,  and  the  develop- 
ment of  new  breeds  has,  consequently,  been  a  slow 
process.  Of  this  fundamental  part  of  his  theory,  so 
directly  an  outcome  of  the  personal  observations  of 
an  Englishman  of  Darwin's  class  and  associations, 
he  gave  a  fuller  treatment  in  a  later  work —  "The 
Variation  of  Animals  and  Plants  under  Domestica- 
tion" (1868). 

"Why  if  man  can  by  patience  select  variations 
most  useful  to  himself,  should  nature  fail  in  selecting 
variations  useful,  under  changing  conditions  of  life, 
to  her  living  products?"  Even  in  the  same  species 
no  two  individuals  are  cast  in  precisely  the  same 
mould.  This  holds  true  of  plants  and  animals  in  a 
state  of  nature  as  in  those  under  domestication. 
Owing  to  the  struggle  for  life,  the  fierceness  of  which 
had  in  Darwin's  judgment  not  been  fully  appre- 
ciated by  Lyell  and  others  who  had  treated  of  it,  any 
variation,  however  slight,  in  any  degree  profitable 
to  the  individual,  "will  tend  to  the  preservation  of 


THEORY  OF  ORGANIC  EVOLUTION  307 

that  individual,  and  will  generally  be  inherited  by 
his  offspring.  The  offspring,  also,  will  thus  have  a 
better  chance  of  surviving,  for,  of  the  many  indi- 
viduals of  any  species  which  are  periodically  born, 
but  a  small  number  can  survive.  I  have  called  this 
principle,  by  which  each  slight  variation,  if  useful, 
is  preserved,  by  the  term  of  Natural  Selection,  in 
order  to  mark  its  relation  to  man's  power  of  selec- 
tion." This  process  of  natural  selection  Darwin 
considered  the  main  but  not  the  exclusive  means  of 
modification. 

What  are  the  proofs  that  the  one  million  and  more 
living  species  now  found  on  the  earth  owe  their 
origin  to  development  from  other  species,  that  is,  to 
Evolution,  rather  than  to  acts  of  Special  Creation? 
Darwin  helps  us  to  answer  this  question  by  indi- 
cating that  in  spite  of  the  incompleteness  of  the 
geological  record  it  is  evident  that  all  extinct  or- 
ganic beings  fall  into  the  same  system  with  living 
beings,  and  that  a  continuity  may  be  observed  to 
exist  between  classes  of  extinct  and  classes  of  living 
plants  and  animals,  as,  for  example,  between  the 
fossil  and  the  recent  marsupials  of  Australia,  and 
between  the  fossil  and  the  recent  edentata  of  Amer- 
ica. The  facts  of  geographical  distribution  prove 
that,  besides  this  succession  or  continuity  in  time, 
there  is  between  like  groups  of  living  beings  a  degree 
of  contiguity  in  space.  Just  so  far  as  they  are  not 


308    THE  HISTORY  OF  MEDICINE 

liable  to  the  invasion  of  plants  and  animals  conti- 
nents have  their  own  characteristic  faunas  and 
floras.  The  species  of  oceanic  islands  are  related  to 
the  species  of  that  mainland  from  which  they  are 
most  accessible  to  the  immigration  of  plants  and 
animals.  In  addition  to  the  lines  of  proof  suggested 
by  the  facts  of  geological  succession  and  geographical 
distribution  Darwin  points  out  the  interrelationship 
of  all  organic  beings.  This  is  the  argument  from 
classification. 

On  this  subject  he  writes  as  follows:  " It  is  a  truly 
wonderful  fact  —  the  wonder  of  which  we  are  apt 
to  overlook  from  familiarity  —  that  all  animals  and 
all  plants  throughout  all  time  and  space  should  be 
related  to  each  other  in  group  subordinate  to  group, 
in  the  manner  which  we  everywhere  behold  — 
namely,  varieties  of  the  same  species  most  closely 
related  together,  species  of  the  same  genus  less 
closely  and  unequally  related  together,  forming 
sections  and  sub-genera,  species  of  distinct  genera 
much  less  closely  related,  and  genera  related  in  dif- 
ferent degrees,  forming  sub-families,  families,  or- 
ders, sub-classes,  and  classes.  .  .  .  On  the  view  that 
each  species  has  been  independently  created,  I  can 
see  no  explanation  of  this  great  fact;  but,  to  the  best 
of  my  judgment,  it  is  explained  through  inheritance 
and  the  complex  action  of  natural  selection,  entail- 
ing extinction  and  divergence  of  character."  More- 


THEORY  OF  ORGANIC  EVOLUTION  309 

over,  the  doctrine  of  common  inheritance  enables 
us  to  explain  the  likenesses  among  organisms  re- 
vealed by  the  study  of  rudimentary  organs,  embry- 
ology, and  morphology  in  general. 

It  is  with  the  consideration  of  these  likenesses 
that  Darwin  begins  his  volume  on  "The  Descent  of 
Man"  (1871),  which  undertakes  to  make  good  the 
prediction  contained  in  the  "Origin  of  Species"  that 
through  the  principles  laid  down  in  that  work  light 
would  be  thrown  on  the  origin  of  man  and  his  his- 
tory. The  general  anatomical  structure  of  man  is 
analogous  to  that  of  other  mammals.  The  human 
skeleton  may  be  compared  bone  for  bone  with  the 
skeleton  of  the  monkey,  bat,  or  seal.  The  "Origin 
of  Species"  had  mentioned  the  structural  resem- 
blance of  the  hand  of  man,  the  wing  of  the  bat,  the 
fin  of  the  porpoise,  and  the  leg  of  the  horse,  as  well 
as  the  likeness  in  the  number  of  cervical  vertebrae  of 
creatures  so  different  as  the  elephant  and  the  giraffe. 
A  similar  correspondence  is  found  in  the  muscles, 
blood-vessels,  viscera,  and  nerves  of  man  and  the 
lower  mammalia.  The  chief  fissures  and  convolu- 
tions of  the  human  brain  are  comparable  to  those  in 
the  brain  of  the  orang-outang.  Moreover,  the  fact 
that  man  is  liable  to  certain  communicable  and  in- 
communicable diseases  that  affect  the  lower  animals 
seemed  to  Darwin  to  indicate  a  close  similarity  of 
tissues  and  blood. 


310    THE  HISTORY  OF  MEDICINE 

Embryonic  development  begins  in  man  as  in  the 
lower  animals  with  the  ovum.  In  the  human  em- 
bryo the  arteries  run  in  arch-like  branches  as  in 
animals  with  functioning  gills;  the  heart  exists  as  a 
simple  pulsating  vessel;  the  os  coccyx  projects  like  a 
true  tail.  "  In  the  embryos  of  all  air-breathing  verte- 
brates, certain  glands,  called  the  corpora  Wolffiana, 
correspond  with  and  act  like  the  kidneys  of  mature 
fishes."  The  convolutions  in  the  brain  of  the  human 
foetus  at  the  end  of  the  seventh  month  correspond 
in  their  development  to  those  of  the  adult  baboon. 
In  the  embryo  the  great  toe  is  shorter  than  the  other 
toes,  and  projects  at  an  angle  from  the  side  of  the 
foot,  as  in  the  adult  simian.  In  1859  Darwin  had 
explained  the  similarity  of  the  embryonic  forms  of 
mammals,  birds,  and  reptiles  on  the  principle  of 
common  ancestry. 

The  study  of  rudimentary  organs,  vestigial  struc- 
tures, arrested  developments,  and  reversions,  fur- 
nished Darwin  with  further  evidence  of  man's  hum- 
ble origin.  In  this  connection  he  mentions  the  vermi- 
form appendix,  the  os  coccyx  and  filum  terminate, 
traces  of  a  supra-condyloid  and  an  inter-condyloid 
foramen,  the  mammse  of  males  (sometimes  fully 
developed  and  functioning),  supernumerary  mam- 
mae, the  nictitating  membrane,  cleft-palate,  and  the 
imperfectly  developed  wisdom-teeth.  As  regards 
the  canine  teeth  he  cites  Haeckel's  observation  that 


THEORY  OF  ORGANIC  EVOLUTION  311 

in  every  large  collection  of  human  skulls  some  may 
be  found  with  the  canine  teeth  projecting  consider- 
ably beyond  the  others  as  in  the  anthropomorphous 
apes,  but  in  a  less  degree.  "He,"  writes  Darwin, 
"who  rejects  with  scorn  the  belief  that  the  shape  of 
his  own  canines,  and  their  occasional  great  develop- 
ment in  other  men,  are  due  to  our  early  forefathers 
having  been  provided  with  these  formidable  weap- 
ons, will  probably  reveal  by  sneering,  the  line  of  his 
descent.  For  though  he  no  longer  intends,  nor  has 
the  power,  to  use  these  teeth  as  weapons,  he  will 
unconsciously  retract  his  'snarling  muscles'  (thus 
named  by  Sir  C.  Bell),  so  as  to  expose  them  ready 
for  action,  like  a  dog  prepared  to  fight."  (At  the 
time  Darwin  wrote  this  passage  —  rather  excep- 
tional in  its  tone  —  he  was  planning  to  publish  his 
work  "The  Expression  of  the  Emotions  in  Man  and 
Animals,"  a  subject  suggested  to  him  by  Bell's 
work  "Anatomy  of  Expression.") 

The  panniculus  carnosus,  and  the  structures  as- 
sociated in  the  same  system  with  it,  especially  the 
functionless  muscles  of  the  ear,  are  not  overlooked 
by  Darwin.  The  frequency  of  deviations  from  the 
so-called  "normal"  musculature  is  a  commonplace 
observation  in  every  dissecting  room.  One  anatomist 
has  recorded  two  hundred  and  ninety-five  muscular 
variations  in  thirty-six  subjects.  Many  muscles 
found  occasionally  in  the  human  subject  correspond 


312    THE  HISTORY  OF  MEDICINE 

to  muscles  usually  found  in  monkeys  and  other 
mammals.  Darwin's  tubercle,  malformations  of  the 
external  ear,  the  arrested  brain-development  of 
idiots,  the  persistence  and  distribution  of  hair,  sup- 
port the  evidence  afforded  by  the  muscles,  teeth,  etc. 
Moreover,  monstrosities  are  "so  similar  in  man  and 
the  lower  animals,  that  the  same  classification  and 
the  same  terms  can  be  used  for  both,  as  has  been 
shown  by  Isidore  Geoffroy  St.  Hilaire." 

A  great  deal  of  space  in  "The  Descent  of  Man"  is 
given  to  the  development  of  the  intellectual  and 
moral  processes  in  man  and  the  lower  animals,  and, 
as  we  have  seen  in  a  previous  chapter,  to  a  consider- 
ation of  secondary  sexual  characters.  Darwin  thus 
affords  a  biological  basis  for  the  psychology  of  the 
cognitions,  volitions,  and  emotions.  Into  the  choice 
of  a  mate,  influenced  by  voice,  brilliant  plumage, 
and  other  secondary  sexual  characters,  a  conscious 
—  aesthetic  —  element  enters.  Since  sexual  selec- 
tion involves  consciousness,  it  may  be  viewed  in  re- 
lation to  artificial  selection ;  in  fact,  sexual  selection 
as  between  man  and  woman  is  a  matter  of  artificial 
selection.  Therefore  it  is  not  surprising  that  Darwin 
should  reach  the  following  conclusion:  "Man  scans 
with  scrupulous  care  the  character  and  pedigree  of 
his  horses,  cattle,  and  dogs  before  he  matches  them ; 
but  when  he  comes  to  his  own  marriage  he  rarely  or 
never  takes  any  such  care.  He  is  impelled  by  nearly 


THEORY  OF  ORGANIC  EVOLUTION  313 

the  same  motives  as  the  lower  animals,  when  they 
are  left  to  their  own  free  choice,  though  he  is  in  so 
far  superior  to  them  that  he  highly  values  mental 
charms  and  virtues.  On  the  other  hand  he  is  strongly 
attracted  by  mere  wealth  or  rank.  Yet  he  might  by 
selection  do  something  not  only  for  the  bodily  con- 
stitution and  frame  of  his  offspring,  but  for  their 
intellectual  and  moral  qualities.  Both  sexes  ought 
to  refrain  from  marriage  if  they  are  in  any  marked 
degree  inferior  in  body  or  mind ;  but  such  hopes  are 
Utopian  and  will  never  be  even  partially  realized 
until  the  laws  of  inheritance  are  thoroughly  known." 
Darwin's  doctrine  of  pangenesis  (1868),  which  he 
put  forward  as  a  tentative  hypothesis  which  could 
be  given  up  as  soon  as  any  better  might  be  found, 
has  been  described  by  Weismann  (1834-1914),  the 
spokesman  of  the  Neo-Darwinians,  as  the  first 
theory  of  heredity  worthy  of  the  name.  Weis- 
mann's  own  theory  of  the  continuity  of  the  germ- 
plasm  (1885)  was  anticipated  to  some  extent  by 
Francis  Galton  in  the  year  following  the  appearance 
of  "The  Descent  of  Man."  Haeckel,  another  early 
German  disciple  of  Darwin,  speaks  of  the  English 
naturalist's  influence  in  every  branch  of  biology, 
especially  in  comparative  anatomy  and  ontogeny, 
and  in  zoological  and  botanical  classification.  It 
was  indeed  revolutionary.  "Darwin's  extraordi- 
nary marshalling  of  facts,"  says  Garrison,  "in  evi- 


3H    THE  HISTORY  OF  MEDICINE 

dence  of  the  survival  of  the  fittest  by  natural  selec- 
tion in  the  struggle  for  existence,  had  the  same  far- 
reaching  influence  upon  biological  speculation  that 
the  discoveries  of  Copernicus  had  upon  astronomy. 
...  It  created  the  sciences  of  comparative  physiol- 
ogy and  pathology,  by  pointing  to  the  close  struc- 
tural and  functional  relationship  between  human 
tissues  and  those  of  animals  and  plants." 

It  is  important  that  the  student  of  medicine 
should  recognize  that  many  problems  concerning 
the  relation  of  inheritance  to  pathology  still  await 
solution.  How  shall  we  explain  the  facts  of  heredi- 
tary immunity,  such  as  Darwin  noted  in  negroes  as 
regards  malaria  and  yellow  fever,  or  such  as  have 
been  observed  in  individuals  in  epidemics  of  cholera 
and  other  deadly  diseases?  How  shall  we  account 
for  the  transmission  of  familial  diseases  like  Fried- 
reich's  ataxia,  or  of  such  hereditary  defects  as  hae- 
mophilia, color-blindness,  deaf-mutism,  and  poly- 
dactylism?  Has  pathology  solved  the  problems  of 
hereditary  predispositions  and  diatheses?  What 
vestigial  structures  are  pathogenic?  What  diseases 
or  malformations  have  resulted  from  the  assump- 
tion of  the  erect  posture? 

REFERENCES 

Bland-Sutton,  Sir  John:  Evolution  and  Disease.   1890. 
Darwin,  Charles:  (i)  The  Origin  of  Species.   1859. 

(2)  The  Descent  of  Man.   1871. 
Osborn,  H.  F.:  From  the  Greeks  to  Darwin.   1894. 


THEORY  OF  ORGANIC  EVOLUTION  315 

Poulton,  E.  B. :  Charles  Darwin,  and  the  Theory  of  Natural  Selec- 
tion.  1896. 

Scott,  W.  B.:   The  Theory  of  Evolution.   1919. 

Weismann,  August:    The  Evolution  Theory  (translated  from  the 
second  German  edition,  1904,  by  J.  A.  and  Margaret  R. 
Thomson).    2  vols.    1904. 
See  also  references  on  page  212  of  the  author's  Introduction  to 

the  History  of  Science. 


CHAPTER  XVI 
THE  FOUNDERS  OF  BACTERIOLOGY 

IN  1820  Ozanam,  a  French  historian  of  epidemic  and 
infectious  diseases,  wrote  that  many  writers  had 
dealt  with  the  animal  nature  of  infectious  materials. 
Several  had  maintained  not  only  that  these  develop 
from  animal  substance  but  that  they  are  themselves 
organic  and  living  beings.  Varro,  Columella,  Lucre- 
tius, Father  Kircher,  Lancisi,  ValKsneri,  R6aumur, 
Christ,  Long,  Plenciz,  Menuret,  Rasori,  and  others 
had  supported  this  view.  Fremont  had  maintained 
that  infectious  materials  arise  and  develop  in  the 
body  through  fermentation.  "I  will  not  waste 
time,"  adds  Ozanam,  "in  refuting  these  absurd 
hypotheses." 

Leeuwenhoek,  by  means  of  an  excellent  lens, 
ground  and  mounted  by  himself,  had  observed 
bacteria  as  early  as  1683.  In  1701  Nicolas  Andry 
expressed  the  conviction  that  air,  water,  vinegar, 
fermenting  wine,  beer,  cider,  and  sour  milk  are  full 
of  germs;  that  germs  exist  also  in  blood,  urine,  and 
the  pustules  of  smallpox  patients ;  and  that  mercury 
cures  venereal  disease  because  it  kills  the  invisible 
pathogenic  organisms.  By  the  year  1726  the  doc- 
trine of  the  causal  relationship  between  micro- 


FOUNDERS  OF  BACTERIOLOGY    317 

organisms  and  disease  was  so  notorious  as  to  be 
made  the  subject  of  a  French  satire  ("Systeme  d'un 
m£decin  anglais  sur  la  cause  de  toutes  les  especes  de 
maladies"),  in  which  the  fainter,  the  belly-nipper, 
etc.,  were  playfully  described. 

More  serious  attempts  at  classification  appeared 
before  the  close  of  the  eighteenth  century.  Linnaeus, 
in  the  last  edition  of  his  "Systema  Naturae"  (1768), 
classed  bacteria  along  with  other  microscopic  forms 
in  the  category  "chaos."  In  spite  of  his  distrust  of 
the  observations  of  the  microscopists,  however,  he 
recognized  that  organic  beings  might  be  the  cause 
of  fevers,  venereal  lues,  and  exanthemata.  In  fact, 
in  an  earlier  work  he  had  expressed  the  belief  that 
parasites  cause  measles,  dysentery,  plague,  small- 
pox, etc.  In  1786  was  published  the  "Animalcula 
infusoria  fluviatilia  et  marina"  of  Otto  Friedrich 
M tiller,  of  Copenhagen,  who  under  the  general  name 
of  "infusoria"  sought  to  classify,  according  to  form, 
movement,  and  habitat,  the  microscopic  beings  so 
inadequately  treated  by  Linnaeus.  M  tiller  made 
use  of  the  terms  "monas,"  "bacillus,"  "vibrio" 
"spirillum";  though  he  laid  the  chief  emphasis  on 
differences  of  form,  he  noted  the  serpentine  and 
other  movements  characteristic  of  some  kinds,  and 
the  inclination  of  others  to  form  filaments,  pellicles, 
and  clusters,  and,  above  all,  he  furnished  well-exe- 
cuted illustrations  of  the  organisms  he  had  observed. 


3i8    THE  HISTORY  OF  MEDICINE 

For  a  considerable  time,  however,  the  attention 
of  biologists  was  fixed  on  the  problem  of  the  origin 
of  the  infusoria  rather  than  on  that  of  their  classi- 
fication. Were  they  produced  by  other  living  beings 
like  themselves,  or  did  they  arise  from  inorganic 
substances  by  spontaneous  generation?  As  regards 
creatures  visible  to  the  naked  eye  the  Italian  physi- 
cian Francesco  Redi  had  settled  the  question  of 
spontaneous  generation  by  his  experiments  on  the 
putrefaction  of  meat  in  1668.  The  discovery  of 
micro-organisms,  however,  revived  the  hopes  of  the 
opposition.  By  some  they  were  regarded  as  the  be- 
ginnings of  life,  the  link  between  the  organic  and  the 
inorganic.  In  1745  Needham,  an  English  priest 
living  on  the  Continent,  reported  an  experiment 
that  seemed  to  support  the  doctrine  of  spontaneous 
generation.  He  had  boiled  meat  juice  in  bottles, 
which  he  had  then  carefully  sealed;  nevertheless, 
after  some  time,  animalcula  were  observed  to  have 
developed  in  great  numbers  within  the  closed 
bottles. 

Bonnet  indicated  two  lines  of  attack  on  the  con- 
clusiveness  of  this  experiment:  creatures  so  minute 
as  infusoria  might  find  their  way  into  even  care- 
fully sealed  bottles ;  and  it  was  possible  a  few  living 
forms  might  survive  within  the  bottles  even  after 
the  contents  had  been  boiled.  These  purely  theo- 
retical criticisms  were  supported  by  the  experiments 


FOUNDERS  OF  BACTERIOLOGY    319 

of  Spallanzani  (1729-99),  one  of  the  most  distin- 
guished experimenters  of  the  eighteenth  century. 
In  the  particular  experiments  in  question  he  made 
use  of  flasks  which  could  be  sealed  hermetically.  If 
it  were  true,  he  argued,  that  living  organisms  could 
be  found  in  preparations  that  had  been  boiled  in 
vessels  from' which  the  outside  air  was  excluded, 
then  they  must  ha ve4  arisen  from  germs  or  eggs  on 
the  sides  of  the  container,  in  the  decoction,  or  in  the 
air  within  the  container.  He  heated  his  flasks  in  the 
fire,  poured  into  them  well  boiled  meat  and  seeds, 
and  sealed  the  flasks  hermetically.  Notwithstand- 
ing this  procedure,  living  infusoria  were  present  in 
the  flasks  after  a  few  days.  He  now  supposed  that 
some  germs  might  have  remained  alive  in  the  air 
contained  in  the  flasks.  Therefore,  he  next  poured 
nineteen  different  infusions  into  as  many  flasks, 
sealed  the  flasks,  and  allowed  them  to  stand  for  an 
hour  in  a  large  vessel  of  boiling  water.  Microscopic 
examination  of  the  contents  of  the  nineteen  flasks 
failed  subsequently  to  reveal  the  presence  of  any 
living  organism.  Other  experiments  showed  that  if 
a  flask  were  slightly  cracked  the  air  might  penetrate 
to  the  contents  bearing  with  it  the  living  germs. 
These  experiments  were  reported  in  1767.  It  is  upon 
the  principles  thus  established  by  Spallanzani  that 
modern  canning  industries  are  based. 

Two  objections  were  raised  against  his  experi- 


320    THE  HISTORY  OF  MEDICINE 

ments  —  that  an  insufficient  quantity  of  air  had 
been  allowed  for  the  support  of  life  in  the  infusoria, 
and  that  the  conditions  of  the  experiments  had 
robbed  the  air  of  its  life-supporting  quality.  In  1836 
Franz  Schulze  tried  to  meet  these  criticisms  by 
filtering  the  air  in  a  flask  (containing  an  infusion) 
through  concentrated  sulphuric  acid.  He  renewed 
the  air  in  this  way  for  over  two  months.  The  in- 
fusion remained  free  from,  micro-organisms.  When 
at  the  end  of  that  time,  however,  unfiltered  air  was 
admitted  to  the  infusion,  various  living  forms  de- 
veloped. In  1837  Schwann  used  molten  metal  or  a 
spirit  flame  for  the  same  purpose  as  the  concen- 
trated sulphuric  acid  served  in  Schulze's  experi- 
ment. Both  Schulze  and  Schwann  were  open  to  the 
criticism  of  having  subjected  the  air  to  vitiating 
influences.  In  1854,  however,  Schroder  and  von 
Dusch  showed  that  a  thick  layer  of  cotton  wadding 
sufficed  to  exclude  all  germs,  while  permitting  free 
access  of  air.  In  1861  Pasteur  found  an  even  simpler 
means  of  excluding  germs  while  freely  admitting 
air.  The  infusion  was  placed  in  a  flask  the  neck  of 
which  terminated  in  a  long  stem,  curved  down  and 
then  up  somewhat  like  the  letter  "S."  This  stem 
was  left  open,  and  the  outside  air  allowed  to  enter. 
After  the  infusion  in  the  flask  had  been  boiled,  the 
germs  from  the  outside  air  would  at  first  be  killed 
by  the  steam,  while,  later,  as  the  apparatus  cooled, 


FOUNDERS  OF  BACTERIOLOGY    321 

such  germs  as  found  their  way  into  the  end  of  the 
open  stem  would  be  arrested  in  its  curves. 

It  was  urged  by  Pasteur's  opponents  that  if  altera- 
tions occurring  in  infusions,  after  they  had  been 
duly  boiled,  were  brought  about  solely  through  the 
agency  of  germs  in  the  air,  then  these  germs  must 
everywhere  be  present  in  great  abundance  and 
variety.  Pasteur  replied  that  they  were  much  more 
abundant  in  some  localities  than  in  others,  and  he 
proceeded  to  secure  experimental  proof  of  his  con- 
tention. He  filled  a  large  number  of  flasks  with  in- 
fusion, heated  them  to  the  boiling  point,  and  then 
hermetically  sealed  them.  He  opened  twenty  of 
these  flasks,  sealing  them  again  immediately,  at  the 
foot  of  the  Jural  Alps;  twenty  others  at  an  altitude 
of  eight  hundred  and  fifty  meters  above  sea-level; 
and  an  additional  twenty  at  an  altitude  of  two 
thousand  meters.  On  examining  the  contents  of 
these  sixty  flasks  after  some  days,  it  was  found  that 
eight  out  of  the  first  twenty,  five  out  of  the  second 
twenty,  and  only  one  out  of  the  third  twenty  showed 
the  presence  of  microscopic  beings.  Other  objections 
to  his  doctrine  of  biogenesis  he  proved  to  be  based 
on  careless  experimentation.  "No,"  he  said  at  the 
end  of  his  communication  to  the  Academic  des 
Sciences  in  1864,  "there  is  no  circumstance  known 
to-day  that  permits  us  to  assert  that  microscopic 
beings  have  come  into  the  world  without  germs, 
without  parents  similar  to  themselves." 


322    THE  HISTORY  OF  MEDICINE 

Several  years  before  the  final  overthrow  of  the 
theory  of  spontaneous  generation,  Pasteur  had 
demonstrated  the  part  played  by  germs  in  various 
kinds  of  fermentation.  We  have  seen  in  previous 
chapters  that  an  analogy  had  been  traced  by  the 
predecessors  of  Rhazes  between  fermentation  and 
at  least  one  form  of  disease,  and  that  a  like  compari- 
son was  familiar  in  the  time  of  Sydenham.  Robert 
Boyle  had  declared  that  "He  that  thoroughly  under- 
stands the  nature  of  ferments  and  fermentations 
shall  probably  be  much  better  able  than  he  that 
ignores  them  to  give  a  fair  account  of  divers  phe- 
nomena of  certain  diseases  (as  well  fevers  as  others) 
which  will  perhaps  be  never  properly  understood 
without  an  insight  into  the  doctrine  of  fermenta- 
tions." In  1836  Cagniard  de  la  Tour,  the  French 
physicist,  observed  that  yeast  plays  a  part  in  al- 
coholic fermentation,  that  it  seems  to  be  a  living 
plant,  and  that  its  growth  keeps  pace  with  the  pro- 
cess of  fermentation.  About  the  same  time  Schwann 
arrived  independently  at  like  conclusions. 

Pasteur  was  interested  in  1856  in  fermentation  in 
connection  with  the  manufacture  of  beetroot  alco- 
hol, and  examined  the  globules  of  the  ferment  by 
means  of  the  microscope.  In  the  years  following  he 
succeeded  in  showing  that  lactic  (1857),  tartaric 
(1858),  butyric  (1861),  and  acetic  (1862)  fermenta- 
tions depend  likewise  on  the  presence  of  definite 


FOUNDERS  OF  BACTERIOLOGY    323 

living  organisms.  For  example,  if  Penicillium  glau- 
cum  grows  in  a  racemate  solution,  the  solution 
gradually  becomes  laevo-tartaric.  (Pasteur's  mas- 
terly analysis  of  racemic  acid  into  dextro-tartaric 
and  laevo-tartaric  laid  the  foundation-stone  of 
stereo-chemistry  in  1848.)  In  his  study  of  the  differ- 
ent kinds  of  fermentation  Pasteur  first  determined 
in  which  constituent  of  the  fermentable  substance 
the  characteristic  change  occurred.  In  the  second 
place  he  studied  under  the  microscope  such  organ- 
isms as  invariably  accompanied  the  fermentation  in 
question.  He  then  made  a  solution  of  the  ferment- 
able constituent,  added  such  ingredients  as  he  con- 
ceived necessary  for  the  growth  of  the  organism, 
boiled  the  solution  so  as  to  render  it  free  of  germs, 
and  placed  in  the  solution  thus  prepared  a  trace  of 
the  essential  ferment.  In  this  way  he  put  to  the  test 
his  hypotheses  concerning  the  organic  causes  of 
fermentation.  The  cause  of  butyric  fermentation 
he  found  to  be  a  micro-organism  that  could  live  only 
in  the  absence  of  oxygen,  in  fact,  an  anaerobic  vi- 
brio. Pasteur  followed  up  these  studies  of  fermenta- 
tion by  investigating  the  ammoniacal  decomposi- 
tion of  urine  and  the  part  played  in  so-called  putre- 
faction by  micro-organisms. 

He  now  turned  his  attention  to  the  diseases  of 
wine.  He  soon  found  that  wine  becomes  sour 
through  the  activity  of  Mycoderma  aceti,  the  pres- 


324    THE  HISTORY  OF  MEDICINE 

ence  of  which  is  betrayed  by  the  appearance  of  a 
pellicle  on  the  surface  of  the  liquor,  that  the  bitter- 
ness of  wine  is  owing  to  an  organism  that  shows 
under  the  microscope  branching  and  twisted  fila- 
ments, while  the  turning  and  ropiness  of  wine  result 
from  the  development  of  other  micro-organisms. 
At  the  time  of  these  investigations  Pasteur  had 
become  fully  conscious  of  his  purpose  to  arrive,  as  he 
expressed  it  to  the  Emperor  in  1863,  at  the  knowl- 
edge of  the  causes  of  putrid  and  contagious  diseases. 
After  treating  what  he  called  the  spontaneous  alter- 
ations or  diseases  of  wines,  he  undertook,  at  the 
urgent  request  of  Dumas  (now  a  Senator  and  par- 
ticularly influential  in  the  Ministry  of  Agriculture), 
to  investigate  the  diseases  of  silkworms.  In  1836 
Bassi  had  made  the  remarkable  discovery  that  one 
communicable  disease  of  silkworms,  muscardine,  is 
caused  by  a  fungus,  the  minute  spores  of  which  are 
transferred  from  the  diseased  to  the  healthy  worms 
through  the  atmosphere  or  by  actual  contact.  In 
1857  Naegeli  had  described  the  micro-organism  of 
the  disease,  pebrine,  that  Pasteur  was  now  especially 
called  upon  to  investigate.  After  five  years  of  ardu- 
ous labor  Pasteur  succeeded  in  tracing  out  the  his- 
tory of  this  infection,  devised  means  of  eradicating 
it,  and  discovered  the  cause  of  a  second  disease  of  silk- 
worms, flacherie,  which  he  ascribed  to  an  organism 
that  developed  in  the  intestinal  canal  of  the  worm. 


FOUNDERS  OF  BACTERIOLOGY    325 

In  1871  he  resumed  his  study  of  alcoholic  bever- 
ages, and  undertook  to  discover  the  causes  of  the 
diseases  of  beer.  Why  does  it  become  thick,  sour, 
slimy,  or  putrid?  He  came  to  the  conclusion  that 
every  "  marked  alteration  in  the  quality  of  beer  coin- 
cides with  the  development  of  micro-organisms 
foreign  to  the  nature  of  true  beer  yeast."  Beer  is 
unalterable  so  long  as  it  contains  no  living  germs; 
disease  ferments  will  not  develop  in  bottled  beer 
after  being  heated  to  a  temperature  of  from  50°  to 
55°  C.  When,  says  Pasteur,  we  see  beer  and  wine 
undergo  marked  alterations  because  they  harbor 
micro-organisms,  which  gain  an  entrance  unnoticed 
and  then  increase  enormously  in  numbers,  we  must 
be  convinced  that  similar  experiences  must  befall 
in  the  case  of  the  lower  animals  and  of  man. 

A  number  of  important  advances  in  bacteriology 
prepared  the  way  for  Pasteur's  study  of  anthrax  in 
1877.  The  Bacillus  anthracis  was  observed  as  a 
little  rod-like  structure  in  the  blood  of  animals  that 
had  died  of  anthrax,  or  splenic  fever,  by  Delafond 
in  1838.  In  1850  a  like  observation  was  made  by 
Davaine  (as  well  as  by  Rayer),  who  came  to  recog- 
nize the  importance  of  the  discovery  only  after  read- 
ing Pasteur's  paper  on  butyric  fermentation.  In 
1863  he  inoculated  some  rabbits  with  the  blood  of  a 
sheep  that  had  died  of  anthrax,  and  upon  the  death 
of  the  inoculated  animals  concluded  that  they  also 


326     THE  HISTORY  OF  MEDICINE 

had  succumbed  to  anthrax.  In  that  same  year 
Delafond  studied  the  organisms  under  a  watch 
glass,  saw  the  little  rods  grow  into  filaments,  and 
attempted  to  discover  "the  mechanism  of  fructifi- 
cation." Even  before  the  observations  of  Davaine 
and  Rayer,  Pollender  had  observed  the  bacillus  in 
the  blood  of  cows  that  had  died  of  anthrax  (1849). 
Important  as  are  these  observations  of  this  patho- 
genic micro-organism,  the  cause  of  widespread  in- 
fection, they  are  less  deserving  of  emphasis  in  the 
history  of  bacteriology  than  the  achievements  of 
Ferdinand  Cohn  (1828-98)  and  of  Robert  Koch. 

Cohn's  discovery,  in  1857,  of  the  sporulation  of 
microscopic  organisms  led  to  the  clearing  up  of  a 
number  of  difficulties,  such  as  the  persistence  of 
living  forms  in  infusions  of  hay,  milk,  and  cheese, 
which  had  baffled  experimenters  from  the  time  of 
Spallanzani.  Cohn's  researches  concerning  bacteria 
furnished  a  system  of  classification,  which,  retaining 
what  was  of  value  in  earlier  systems  —  such  as  the 
Hallier's  concept  of  the  micrococcus  and  Ehren- 
berg's  concept  of  the  spirillum  and  the  spirochata 
—  still  dominates  to-day  the  grouping  and  the  no- 
menclature of  schizomycetes.  Cohn  recognized  that 
all  bacteria  are  plants.  He  classified  the  micrococci 
as  chromogenic,  zymogenic,  and  pathogenic.  Among 
the  bacilli  he  mentioned  of  course  the  bacillus 
anthracis.  He  showed,  moreover,  by  striking  calcu- 


FOUNDERS  OF  BACTERIOLOGY    327 

lations  the  marvelously  rapid  increase  of  bacteria 
under  conditions  favorable  to  their  development, 
and  thus  drew  attention  to  the  part  they  play  in  the 
struggle  for  existence.  In  1876  he  observed  the 
germination  of  the  spores  of  certain  bacteria.  In 
April  the  same  year  Koch  announced  to  Cohn  the 
results  of  his  study  of  the  anthrax  bacillus.  To  this 
brilliant  investigation  and  to  Koch's  other  achieve- 
ments we  shall  return  presently. 

At  the  beginning  of  1877  the  French  physiologist 
Paul  Bert  maintained  that  by  the  use  of  compressed 
oxygen  he  could  destroy  the  bacillus  anthracis  in 
the  blood  of  animals  that  had  died  of  anthrax,  and, 
then,  by  inoculating  the  blood  so  treated,  cause 
death  in  the  inoculated  animals  without  the  appear- 
ance of  fresh  bacilli.  Therefore,  he  argued,  the 
bacillus  anthracis  is  neither  the  cause  nor  the  neces- 
sary effect  of  anthrax.  Pasteur,  assisted  by  Joubert, 
tackled  the  subject.  He  found  it  possible  to  obtain 
a  pure  culture  of  the  organism  in  urine  rendered 
neutral  or  slightly  alkaline.  The  inoculation  of  a 
trace  of  this  culture  produced  a  typical  case  of 
anthrax.  How  then  account  for  the  results  of  Bert's 
experimentation?  In  the  first  place  Pasteur  stated 
that  the  spores  of  bacillus  anthracis  could  resist  for 
three  weeks  the  action  of  pure  oxygen  under  a  pres- 
sure of  ten  atmospheres.  In  the  second  place  the 
death  of  animals,  following  the  inoculation  of  the 


328     THE  HISTORY  OF  MEDICINE 

blood  of  anthrax  victims,  without  the  appearance  of 
bacilli  was  really  owing  to  septicaemia,  which  in 
turn  owed  its  development  to  pathogenic  micro- 
organisms. He  was  able  to  point  out  in  the  blood  of 
animals  that  had  died  of  anthrax,  in  addition  to 
bacillus  anthracis,  the  vibrion  septique  (bacillus  of 
malignant  oedema),  which  he  had  himself  discovered. 
Nevertheless,  he  did  not  believe  that  septicaemia  is 
a  specific  infection,  and  he  later  discovered  Staphy- 
lococcus  pyogenes  and  Streptococcus  pyogenes. 
Pasteur  also  discovered  the  pneumococcus. 

Until  Pasteur's  study  of  chicken  cholera  in  1880, 
Edward  Jenner's  great  success  in  the  production  of 
artificial  immunity  remained  an  isolated  phenome- 
non. Some  years  before  this  the  micro-organism  of 
chicken  cholera  had  been  described.  Toussaint  es- 
tablished the  causal  relationship  between  the  or- 
ganism and  the  disease.  Pasteur  found  that  the  best 
culture  medium  was  a  broth  of  chicken  gristle 
neutralized  with  potash,  and  that  the  smallest  drop 
of  a  recent  culture  would  kill  a  chicken.  When,  how- 
ever, hens  were  given  an  old  culture,  which  had  been 
put  away  and  forgotten  for  a  few  weeks,  though 
they  were  affected  by  the  disease  they  did  not  suc- 
cumb to  it.  If  these  hens  were  then  exposed  to  the 
unattenuated  virus,  they  were  either  unaffected,  or 
they  experienced  the  disease  in  a  mild  form.  "Was 
not  this  fact,"  writes  Vallery-Radot,  "worthy  of 


FOUNDERS  OF  BACTERIOLOGY    329 

being  placed  by  the  side  of  the  great  fact  of  vaccina- 
tion, over  which  Pasteur  had  so  long  thought  and 
pondered?"  Was  it  possible  to  develop  an  animal's 
resistance  to  other  infectious  diseases?  By  the  be- 
ginning of  1 88 1  Pasteur  was  able  to  announce  the 
essentials  of  his  preventive  treatment  for  anthrax. 
He  had  found  that  bacillus  anthracis  could  be  culti- 
vated in  neutralized  chicken  broth  at  42°  to  43°  C. 
without  developing  spores,  and  that  by  being  kept 
for  ten  or  twelve  days  the  culture  became  so  at- 
tenuated as  to  give  rise  merely  to  a  benignant  form 
of  the  disease.  Moreover,  the  weakened  culture  can 
be  cultivated  at  30°  to  35°  C.  and  yet  yield  spores 
of  the  same  degree  of  virulence  as  the  bacilli  that 
formed  them.  The  bacilli  may  recover  their  original 
virulence  by  being  passed  through  a  series  of  guinea- 
pigs,  the  second  being  inoculated  with  the  blood 
of  the  first,  and  so  forth.  (Similarly,  the  micro- 
organism of  chicken  cholera,  after  it  has  become 
weakened  through  contact  with  oxygen,  may  be 
strengthened  by  being  passed  through  a  series  of 
sparrows  or  canaries.) 

It  was  the  methods  and  principles  established  by 
these  studies  that  led  to  Pasteur's  successful  treat- 
ment of  hydrophobia  in  1885,  and  to  the  subsequent 
founding  of  the  Pasteur  Institute.  "Here,"  says 
Garrison,  "  Pasteur  labored  almost  to  the  end  of  his 
life,  with  such  brilliant  pupils  as  Metchnikoff,  Roux, 
Yersin,  Calmette,  Chamberland,  and  Pottevin." 


330     THE  HISTORY  OF  MEDICINE 

Robert  Koch  (1843-1910)  born  in  the  Kingdom 
of  Hanover,  was  a  pupil  at  Gottingen  of  the  dis- 
tinguished histologist  Henle,  who  in  1840  had  re- 
vived the  doctrine  of  a  contagium  animatum.  Koch 
took  his  degree  in  1866,  the  year  in  which  Hanover 
was  conquered  and  annexed  by  Prussia.  In  the 
Franco- Prussian  War  he  served  as  a  volunteer  army 
surgeon.  After  the  war  was  over,  he  was  appointed 
district  physician  of  a  small  place  (Wollstein)  in 
Posen.  There  he  devoted  himself  to  the  study  of 
infectious  diseases. 

In  1876  Koch  began  to  publish  the  results  of  his 
investigations  concerning  the  etiology  of  anthrax 
("Die  Aetiologie  der  Milzbrand-Krankheit,  be- 
griindet  auf  die  Entwickelungsgeschichte  des  Bacil- 
lus anthracis").  He  showed  in  the  first  place  that 
mice  develop  anthrax  when  inoculated  with  blood 
containing  the  bacilli;  that  by  successive  inocula- 
tions the  disease  may  be  passed  from  one  to  another 
of  a  long  series  of  mice.  At  the  same  time  he  noted 
the  rapid  growth  of  the  organisms  in  the  blood, 
lymph,  etc.,  and  the  presence  of  countless  numbers 
of  them  in  the  spleens,  of  the  inoculated  animals. 
He  then  proved  that  in  a  suitable  culture  medium, 
such  as  fresh  ox  blood  serum  or  the  aqueous  humor 
of  an  ox's  eye,  at  a  temperature  of  from  18°  to  40°  C. 
and  with  free  access  of  air  the  anthrax  bacilli  grow 
to  great  length  and  develop  numerous  spores.  He 


FOUNDERS  OF  BACTERIOLOGY    331 

had  been  able  to  observe  this  process,  by  means  of 
the  microscope,  in  a  drop  of  aqueous  humor  to  which 
a  small  portion  of  fresh  spleen  containing  bacilli  was 
added.  In  a  fresh  drop  of  aqueous  humor  he  also 
saw  these  spores  develop  into  typical  anthrax 
bacilli.  This  beautiful  piece  of  work,  which  of  itself 
entitles  Robert  Koch  to  a  place  beside  Pasteur  as 
one  of  the  great  founders  of  bacteriology,  placed  in 
his  hands  an  absolutely  pure  culture  of  a  patho- 
genic micro-organism,  and  gave  him  the  means  of 
proving  that  the  bacillus  anthracis  is  the  sole  cause 
of  splenic  fever.  The  spores  on  account  of  their 
resistance  to  the  action  of  prolonged  moisture  or 
dryness  play  of  course  an  important  part  in  the  dis- 
semination of  the  disease. 

In  1878  Koch  published  his  investigations  con- 
cerning the  etiology  of  wound  infections.  He  be- 
lieved that  the  "parasitic"  nature  of  these  diseases 
is  probable,  "but  that  an  adequate  proof  therefor 
had  not  been  given  and  that  such  proof  would  not 
be  forthcoming  till  we  succeed  in  discovering  the 
parasitic  micro-organisms  in  all  cases  of  the  disease 
under  investigation,  till  we  succeed  in  showing  them, 
moreover,  in  such  numbers  and  distribution  as  to 
explain  all  the  morbid  phenomena,  and,  finally  till 
we  succeed  in  establishing  for  every  kind  of  wound 
infection  a  definite,  morphologically  distinct,  micro- 
organism as  the  parasite."  He  sought  to  discover 


332     THE  HISTORY  OF  MEDICINE 

the  characteristic  organisms  in  septicaemia,  pyaemia, 
erysipelas,  etc.,  by  experiments  on  animals,  inject- 
ing into  mice  and  rabbits  such  substances  as  putres- 
cent  meat  infusion  or  blood.  He  was  able  to  study 
the  effects  of  injecting,  into  mice,  blood  impreg- 
nated with  chain-forming  micrococci,  and  to  pro- 
duce in  rabbits  a  disease  markedly  resembling  ery- 
sipelas in  man.  The  main  result  of  this  investigation 
seems  to  have  been  to  strengthen  Koch's  conviction 
of  the  indubitable  differences  of  pathogenic  micro- 
organisms and  of  their  inalterable  constancy  of 
behavior. 

Koch  always  laid  great  stress  on  the  value  for  the 
progress  of  medicine  of  improved  technique  and  new 
methods  of  investigation.  In  1877  he  had  advo- 
cated the  use  of  photography  as  practiced  by  him- 
self in  the  identification  of  microscopic  organisms. 
He  adopted  Weigert's  method  of  staining  with  ani- 
line dyes,  especially  methyl  violet  and  fuchsin,  and 
he  sought  means  to  overcome  the  constant  move- 
ment of  the  micro-organisms  recognized  by  him  as 
one  of  the  chief  obstacles  of  the  investigator.  In 
1 88 1,  a  year  after  he  was  called  to  the  Imperial 
Health  Bureau  in  Berlin,  he  devised  his  method  of 
obtaining  pure  cultures  with  fixed,  coagulable, 
culture  media.  After  he  had  developed  his  method, 
discoveries  fell  into  the  lap  of  the  investigator  like 
ripe  fruit,  as  Koch  himself  said. 


FOUNDERS  OF  BACTERIOLOGY    333 

In  1882  he  announced  the  discovery  of  the  Bacillus 
tuberculosis,  thus  confirming  the  views  of  others  in 
relation  to  the  specific  and  communicable  character 
of  tuberculosis.  In  the  course  of  his  experiments 
carried  on  in  the  hope  of  discovering  a  cure  for 
tuberculosis  Koch  found  that  tuberculous  guinea- 
pigs  differ  from  healthy  guinea-pigs  in  their  manner 
of  reacting  to  inoculations  of  tubercle  bacilli,  alive 
or  dead.  From  this  fact  he  inferred  that  there  was 
in  the  bacilli  a  soluble  substance  which  would  prove 
a  means  of  diagnosis  and  of  control.  His  tuberculin 
—  a  glycerine  extract  of  pure  culture  of  bacilli  — 
was  announced  at  the  International  Medical  Con- 
gress held  at  Berlin  in  1890.  Later  he  produced  a 
new  tuberculin,  which  has  become  recognized  as  of 
great  value  in  diagnosis.  He  held  that  the  bacilli  of 
bovine  tuberculosis  do  not  cause  tuberculosis  in  man. 

In  1883  Koch  went  to  Egypt  and  India  as  leader 
of  the  German  Cholera  Commission:  recognized  in 
amceba^  the  cause  of  tropical  dysentery;  discovered 
in  the  comma  bacillus  the  cause  of  Asiatic  cholera; 
and  in  another  bacillus  the  cause  of  infectious  con- 
junctivitis. In  1885  he  received  appointment  at  the 
University  of  Berlin  as  professor  in  the  faculty  of 
medicine  and  director  of  the  newly  established 
Hygienic  Institute.  In  1891  his  great  powers  as  an 
organizer  were  called  into  play  in  connection  with 
the  new  Institute  for  Infectious  Diseases.  In  the 


334     THE  HISTORY  OF  MEDICINE 

following  year  cholera  broke  out  in  the  city  of  Ham- 
burg, but  the  menace  to  the  fatherland  was  averted 
by  the  medical  science  of  Koch,  always  alive  to  the 
dangers  of  water-borne  infections.  He  further  served 
Germany  by  fighting  typhus  in  the  southwestern 
part  of  the  country,  as  well  as  by  suggesting  sani- 
tary legislation,  and  organizing  conferences.  In 

1896  at  the  request  of  the  British  government  he 
investigated  Rinderpest  in  South  Africa,  and  de- 
veloped a  method  of  preventive  inoculation.    In 

1897  he  studied  bubonic  plague  at  Bombay.  He  had 
recognized  in  1883  that  blood-sucking  insects  are 
transmitters  of  disease,  and  a  considerable  part  of 
the  last  fifteen  years  of  his  life  was  spent  in  the  study 
of  tropical  medicine.  In  1906  he  was  again  in  Africa 
as  head  of  the  Sleeping  Sickness  Commission. 

REFERENCES 

Dudaux,  Emile:  Histoire  d'un  Esprit.  1896.  395  pp. 

Knopf,  S.  A.:   Robert  Koch,  Johns  Hopkins  Hospital  Bulletin, 
1911,  vol.  xxn,  pp.  425-28. 

Koch,  Robert:   (i)  Bacteriological  Diagnosis  of  Cholera  (transla- 
tion by  G.  Duncan).   1894.   150  pp. 

(2)  Investigations  into  the  Etiology  of  Traumatic  Infective 
Diseases  (translation  by  W.  Watson  Cheyne).  1880.   74  pp. 

Roger,  Henri:  "Les  Sciences  Medicates,"  in  the  first  volume  of 
La  Science  Fran(aise.   1915. 

Loffler,    Friedrich:     Vorlesungen   fiber   die    geschichtliche    Ent- 
imckelung  der  Lehre  von  den  Bacterien.    1887.  252  pp. 

Tyndall,   John:   "Spontaneous    Generation,"    Popular  Science 

Monthly,  vol.  12,  1877,  pp.  476-88  and  591-604. 
See  also  references  on  page  230  of  the  author's  Introduction  to 

the  History  of  Science. 


CHAPTER  XVII 
ANTISEPTIC  SURGERY:  LORD  LISTER 

JOSEPH  LISTER,  the  story  of  whose  achievements  in 
surgery  is  so  closely  associated  with  that  of  the  de- 
velopment of  bacteriology,  was  born  in  the  London 
district  (Upton)  April  5,  1827.  He  received  his 
early  schooling  at  two  Quaker  institutions  (his 
family  belonging  to  the  Society  of  Friends),  took  his 
bachelor's  degree  at  University  College,  London, 
proceeded  at  the  age  of  twenty-one  to  his  profes- 
sional education  at  the  University  College  Hospital 
and  Medical  School,  and  at  the  age  of  twenty-five 
received  the  M.B.  and  F.R.C.S.  He  had  already 
come  in  contact  with  several  men  whose  names  are 
known  in  the  history  of  science:  Joseph  Jackson 
Lister,  his  father,  already  referred  to  as  contributing 
to  the  production  of  the  achromatic  lens;  Thomas 
Graham,  who  formulated  the  law  of  the  diffusion  of 
gases;  W.  B.  Carpenter,  whose  work  on  "Mental 
Physiology"  has  had  a  great  effect  on  the  progress 
of  psychology;  William  Jenner,  who  during  Lister's 
early  years  as  a  student  of  medicine  was  working 
out  the  distinction  between  typhus  fever  and  ty- 
phoid; William  Sharpey,  the  distinguished  teacher 
of  physiology;  and  Wharton  Jones,  noted  as  an 


336     THE  HISTORY  OF  MEDICINE 

ophthalmic  surgeon  and  as  one  of  the  pioneers,  in 
England,  in  the  study  of  embryology.  Before  tak- 
ing his  degrees  in  medicine  Lister  had  served  six 
months  as  house  physician  and  nine  months  as 
house  surgeon  (to  Erichsen)  at  the  University  Col- 
lege Hospital. 

Among  the  results  of  his  extended  education  were 
a  considerable  command  of  ancient  and  modern 
languages,  skill  as  a  draughtsman  and  microscopist, 
love  of  scientific  truth  and  a  taste  for  research.  In 
1853,  the  year  following  his  graduation  in  medicine, 
he  published  two  papers  in  the  "Quarterly  Journal 
of  Microscopical  Science."  The  first  of  these  re- 
corded the  discovery  of  the  sphincter  and  the  dilator 
of  the  iris  as  distinct  muscles,  and  confirmed  the 
views  of  Kolliker  as  regards  the  nonstriated  and  the 
cellular  structure  of  the  tissue  in  question.  The 
second  paper,  illustrated  like  the  first  by  delicate 
drawings,  dealt  with  the  arrectores  pili,  especially 
those  of  the  scalp.  He  prepared  his  sections  by  tying 
the  tissue  to  be  examined  between  two  thin  slips  of 
pine  and  allowing  it  to  dry  for  twenty-four  hours, 
by  which  time  the  piece  of  scalp  having  adhered  to 
one  of  the  slips  could  be  cut,  by  means  of  a  sharp 
razor,  in  very  fine  shavings  along  with  the  wood  in 
any  plane  desired.  This  was  an  original  form  of 
microtome. 

In  the  autumn  of  1853  Lister  went  to  Edinburgh, 


ANTISEPTIC  SURGERY  337 

on  the  advice  of  Sharpey,  in  order  to  attend  the 
surgical  clinics  of  Syme,  an  excellent  teacher  and 
the  foremost  surgeon  at  that  time  in  Great  Britain. 
The  young  man  was  very  cordially  received.  He  be- 
came a  frequent  visitor  in  Syme's  home,  where  he 
met  a  large  number  of  agreeable  and  cultured  people, 
among  them  Dr.  John  Brown,  the  author  of  "  Rab 
and  his  Friends."  In  the  congenial  society  of  Edin- 
burgh, a  city  more  beautiful  then  even  than  now, 
Lister  threw  off  much  of  his  natural  shyness  and 
restraint,  though,  in  spite  of  the  favor  his  accom- 
plishments and  admirable  disposition  gained  for 
him,  he  never  lost  his  native  modesty.  He  soon  be- 
came Syme's  house  surgeon  at  the  Royal  Infirmary, 
where  in  this  period  following  the  introduction  of 
the  use  of  anaesthetics,  he  had  abundant  oppor- 
tunities to  develop  skill  as  an  operator.  About  this 
time  he  wrote  home:  "If  the  love  of  surgery  is  a 
proof  of  a  person's  being  adapted  for  it,  then  cer- 
tainly I  am  fitted  to  be  a  surgeon;  for  thou  canst 
hardly  conceive  what  a  high  degree  of  enjoyment  I 
am  from  day  to  day  experiencing  in  this  bloody  and 
butcherly  department  of  the  healing  art."  The 
young  house  surgeon  had  twelve  dressers,  who 
called  him  "The  Chief,"  a  title  he  retained  for  life 
among  his  many  loyal  disciples.  In  the  autumn  of 
1855  he  gave  an  extra-mural  course  of  lectures  on 
surgery.  In  the  following  spring  he  married  Syme's 


338     THE  HISTORY  OF  MEDICINE 

daughter  Agnes.  A  three  months'  tour  of  the  Conti- 
nent followed,  during  which  the  young  couple  met 
Rokitansky,  Albrecht  von  Graefe,  and  other  dis- 
tinguished people.  In  the  autumn  of  1856,  after 
their  return  to  Edinburgh,  Lister  was  appointed 
assistant  surgeon  at  the  Royal  Infirmary. 

Among  the  many  papers  prepared  by  him  during 
these  early  years  in  Edinburgh  the  most  important 
is  that  on  "The  Early  Stages  of  Inflammation," 
read  before  the  Royal  Society  of  London  in  1857. 
It  was  the  product  of  a  long  series  of  investigations, 
probably  suggested  by  some  studies  of  Wharton 
Jones.  Lister's  conclusions  were  based  on  an  ex- 
perimental study  of  the  circulation  in  the  web  of  the 
frog's  foot  and  of  the  bat's  wing.  He  had  begun  his 
experiments  on  the  frog  in  September,  1855.  In  a 
letter  written  at  that  time  he  says:  "  Mr.  Sparshott, 
the  most  intelligent  of  the  last  set  of  dressers,  and 
who  is  to  attend  my  lectures  in  the  winter,  kindly 
assisted  me,  and  a  glorious  night  I  had  of  it.  I  had 
the  frog  so  placed  and  fixed  that  I  could  inject  any- 
thing upon  the  web  under  the  microscope  from  a 
syringe,  and  it  so  happened  that  the  frog  was  not 
only  perfectly  healthy,  but  with  remarkably  little 
pigment,  and  exceedingly  quiet.  By  using  a  2/3  ob- 
ject-glass I  had  a  fine  large  field  of  view,  and  had 
under  observation  always  the  same  artery,  with  the 
field  of  capillaries  into  which  it  divided  and  the  two 


ANTISEPTIC  SURGERY          339 

veins  which  returned  the  blood  from  them ;  and  thus 
was  able  to  watch  with  great  precision  the  effects 
produced;  the  animal  rarely  struggling  at  all." 
Under  these  conditions  he  began  by  applying  to  the 
web  warm  water,  which  first  checked  and  then  stim- 
ulated the  circulation.  He  followed  up  this  pro- 
cedure by  applying  water  of  higher  and  higher 
temperature  till  the  boiling  point  was  approached. 
Finally  the  capillaries  were  greatly  "distended  and 
stuffed  with  the  red  corpuscles,  and  the  blood  was 
first  retarded,  then  stagnant." 

Lister  continued  these  studies  of  the  circulation 
by  a  series  of  obervations  and  experiments  con- 
cerning a  closely  related  subject,  namely,  the  coagu- 
lation of  the  blood.  A  case  of  so-called  spontaneous 
gangrene,  in  which  he  had  been  forced  to  resort  to 
amputation,  led  him  to  the  conclusion  that  obstruc- 
tion to  the  circulation  had  been  caused  primarily  by 
a  diseased  condition  of  the  vessels.  This  case  was 
reported  in  the  early  part  of  the  year  1858  (just 
when  Virchow  was  giving  his  lectures  in  Berlin  on 
"Cellular  Pathology").  At  the  same  time  Lister 
reported  that  he  had  drawn  off  the  blood  of  a  sheep 
into  a  vulcanized  rubber  tube,  which  he  then  di- 
vided into  a  number  of  closed  compartments,  and 
that  the  blood  remained  fluid  for  three  hours.  When 
the  blood  was  allowed  to  escape  from  the  tube,  it 
coagulated,  of  course,  in  about  three  minutes,  just 


340     THE  HISTORY  OF  MEDICINE 

as  if  it  had  been  drawn  fresh  from  the  veins  of  the 
animal.  Moreover,  by  ligating  the  vessels  in  the 
amputated  leg  of  a  sheep  or  a  cat  he  could  keep 
blood  uncoagulated  for  several  days.  After  other 
papers  dealing  with  the  coagulation  of  the  blood 
Lister  delivered  the  Croonian  lecture  on  that  sub- 
ject before  the  Royal  Society  of  London  in  1863. 
Though  he  had  been  considerably  influenced  by  the 
work  of  Hunter,  he  refused  to  commit  himself  to  the 
vitalistic  hypothesis  as  regards  coagulation,  nor,  as 
he  said,  "to  any  particular  theory  of  the  nature  of 
life,  or  even  to  the  belief  that  the  actions  of  living 
bodies  are  not  all  conducted  in  obedience  to  physical 
and  chemical  laws."  He  was  more  and  more  inclined 
to  emphasize  the  influence  on  coagulation  of  foreign 
solids,  and  of  diseased  tissues  which  acted  like 
foreign  solids. 

At  the  beginning  of  1860  Lister  had  been  ap- 
pointed professor  of  surgery  at  the  University  of 
Glasgow.  At  that  institution  he  was  the  colleague 
of  Allen  Thomson,  the  anatomist  and  embryologist, 
to  whom  he  was  largely  indebted  for  his  appoint- 
ment, of  Sir  William  Thomson  (afterwards  Lord 
Kelvin),  professor  of  physics,  and  of  other  men  dis- 
tinguished in  letters  and  science.  He  sent  his  father 
an  interesting  account  of  his  induction  as  a  member 
of  the  Faculty.  The  ancient  rite  demanded  that  the 
new  professor  should  give  a  dissertation  in  Latin; 


ANTISEPTIC  SURGERY  341 

but  Lister  was  summoned  to  the  ceremony  on  very 
short  notice,  did  not  set  pen  to  paper  till  the  morn- 
ing of  the  day  on  which  he  was  to  appear  before  his 
colleagues,  and  wrote  the  last  third  of  his  disquisi- 
tion while  on  the  train  from  Edinburgh  to  Glasgow. 
He  acquitted  himself  creditably,  and  was  soon  busy 
with  his  large  classes  and  considerable  private  prac- 
tice. He  faced  additional  responsibilities  when  in 
the  following  year  he  received  appointment  as 
surgeon  in  the  Glasgow  Royal  Infirmary. 

In  order  to  appreciate  the  benefits  Lister  con- 
ferred upon  surgery  one  must  know  something  of 
the  condition  of  the  hospitals  before  the  introduction 
of  the  antiseptic  system.  After  the  use  of  ether  and 
chloroform  had  become  general,  operations  gradu- 
ally increased  both  in  number  and  range.  Although 
deaths  from  shock  grew  less  frequent,  the  pres- 
ence of  septicaemia,  pyaemia,  erysipelas,  and  hospi- 
tal gangrene,  etc.,  caused  an  alarming  mortality. 
Worst  of  all,  writes  Sir  Rickman  Godlee,  Lister's 
nephew  and  biographer,  "was  the  appearance  of  the 
moist  grey  slough  surrounded  by  an  angry  blush, 
which  heralded  the  onset  of  hospital  gangrene.  The 
limits  of  the  original  wound  were  then  lost  sight  of. 
What  might  be  the  shape  or  size  or  even  the  posi- 
tion of  the  scar  in  the  event  of  the  patient's  recovery 
became  a  matter  of  the  greatest  uncertainty,  be- 
cause it  was  impossible  to  foresee  the  amount  of 


342     THE  HISTORY  OF  MEDICINE 

tissue  which  would  perish  from  the  destructive 
effects  of  the  disease  and  the  heroic  measures  taken 
to  combat  it."  These  diseases  were  particularly  rife 
in  the  large  hospitals.  Sir  James  Simpson  led  the  at- 
tack on  "  Hospitalism  "  (1869).  A  statistical  inquiry 
conducted  by  him  showed  that  out  of  2098  amputa- 
tions in  country  practice  226  had  proved  fatal,  and 
that  out  of  2089  amputations  in  hospital  practice 
855  had  proved  fatal ;  and  that  the  larger  the  hospi- 
tal the  greater  the  mortality.  "Most  hospital  sur- 
geons," he  said,  "ever  remain  content  with  losing 
one-third  to  one  half  of  all  their  amputation  cases, 
and  nine  tenths  of  some."  Institutions  which  had 
been  developed  through  centuries  of  philanthropic 
endeavor  were  proving  a  curse,  unable  to  meet  the 
needs  of  the  cities  ever  increasing  in  size  as  a  result 
of  the  industrial  revolution. 

Lister  in  his  new  appointment  had  to  face  the 
practical  problems  of  controlling  these  diseases,  the 
only  solution  of  which  had  seemed  to  many  able 
surgeons  the  demolition  of  the  hospitals.  Glasgow, 
with  a  population  of  390,000,  was  then,  as  now,  one 
of  the  industrial  centers  of  Great  Britain,  and  in 
1861  the  Glasgow  Royal  Infirmary  was  no  better 
than  other  city  hospitals.  Sir  Hector  Cameron,  at 
one  time  Lister's  house  surgeon  and  assistant,  says 
that  every  wound  discharged  pus  freely,  and  putre- 
factive changes  occurred  in  the  discharges  of  all. 


ANTISEPTIC  SURGERY  343 

"Secondary  haemorrhage,"tetanus,  erysipelas,  septi- 
caemia, pyaemia,  and  hospital  gangrene,"  he  pro- 
ceeds, "were  never  all  absent  from  the  hospital 
wards,  and  at  times  pyaemia  and  hospital  gangrene 
became  alarmingly  epidemic."  Lister,  though  he 
had  for  some  time  past  taught  that  suppuration  is  a 
form  of  putrefaction,  was  still  without  the  clue  to  a 
real  explanation  of  putrefactive  changes.  Even  after 
his  successes  had  begun,  a  terrible  state  of  affairs 
was  discovered  at  the  Royal  Infirmary.  "A  few 
inches  below  the  surface  of  the  ground,"  he  writes, 
"on  a  level  with  the  floors  of  the  two  main  accident 
wards,  with  only  the  basement  area,  a  few  feet  wide, 
intervening,  was  found  the  uppermost  tier  of  a 
multitude  of  coffins,  which  had  been  placed  there 
at  the  time  of  the  cholera  epidemic  of  1849,  the 
corpses  having  undergone  so  little  change  in  the 
interval  that  the  clothes  they  had  on  at  the  time  of 
their  hurried  burial  were  plainly  distinguishable." 
He  was  horrified  also  by  the  custom  of  the  "pit 
burial"  of  paupers  still  practiced  in  the  old  cathedral 
churchyard  adjoining  the  Infirmary,  more  particu- 
larly as  he  associated  infectious  disease  with  a  con- 
taminated state  of  the  atmosphere.  Such  were  the 
circumstances  in  which  Lister  developed  his  method 
of  antiseptic  surgery. 

In  1864  he  was  especially  interested  in  the  study 
of  suppuration   (in  relation  to  decomposition),  a 


344     THE  HISTORY  OF  MEDICINE 

subject  to  which  he  had  given  considerable  atten- 
tion since  his  student  days.  He  was  therefore  very 
deeply  interested  in  the  fact  that  carbolic  acid  had 
proved  effective  at  Carlisle  not  only  in  deodorizing 
the  sewage,  but  even  in  destroying  the  entozoa  that 
had  infested  the  cattle  in  the  fields  fertilized  by  the 
sewage.  It  occurred  to  him  that  carbolic  acid  might 
prevent  suppuration  in  cases  of  compound  fracture. 
He  had  long  felt  that  to  make  an  open  wound  behave 
like  a  closed  one  would  be  a  notable  advance  in 
scientific  surgery.  The  first  attempt  to  use  carbolic 
acid  in  the  treatment  of  compound  fracture  was  not 
successful.  This  was  in  the  spring  of  1865,  the  year 
in  which  Lister's  attention  was  first  directed  to 
Pasteur's  studies  of  fermentation  and  putrefaction. 
In  August  of  the  same  year,  however,  the  new 
method  was  employed  with  complete  success  in  a 
case  of  compound  fracture  of  the  tibia.  The  patient 
was  a  boy  of  eleven,  who  had  been  run  over  by  a 
wagon.  Lister  felt  that  recovery  was  as  rapid  and 
satisfactory  as  if  the  fracture  had  been  merely  a 
simple  one. 

In  announcing  this  and  other  successes  Lister  said : 
"In  the  course  of  an  extended  investigation  into 
the  nature  of  inflammation,  and  the  healthy  and 
morbid  conditions  of  the  blood  in  relation  to  it,  I 
arrived,  several  years  ago,  at  the  conclusion  that  the 
essential  cause  of  suppuration  in  wounds  is  decom- 


ANTISEPTIC  SURGERY  345 

position,  brought  about  by  the  influence  of  the  atmo- 
sphere upon  blood  or  serum  retained  within  them, 
and,  in  the  case  of  contused  wounds,  upon  portions 
of  tissue  destroyed  by  the  violence  of  the  injury. 

"To  prevent  the  occurrence  of  suppuration,  with 
all  its  attendant  risks,  was  an  object  manifestly 
desirable;  but  till  lately  apparently  unattainable, 
since  it  seemed  hopeless  to  attempt  to  exclude  the 
oxygen,  which  was  universally  regarded  as  the  agent 
by  which  putrefaction  was  effected.  But  when  it  had 
been  shown  by  the  researches  of  Pasteur  that  the 
septic  property  of  the  atmosphere  depended,  not 
on  the  oxygen  or  any  gaseous  constituent,  but  on 
minute  organisms  suspended  in  it,  which  owed  their 
energy  to  their  vitality,  it  occurred  to  me  that  de- 
composition in  the  injured  part  might  be  avoided 
without  excluding  the  air,  by  applying  as  a  dressing 
some  material  capable  of  destroying  the  life  of  the 
floating  particles." 

At  the  time  of  this  statement  —  March,  1867  — 
the  list  of  successful  cases  of  compound  fractures, 
abscesses,  contused  and  lacerated  wounds,  amputa- 
tions, strangulated  inguinal  hernias,  etc.,  had  grown 
so  great  that  Lister  felt  impelled  to  impart  the 
knowledge  of  his  procedure  to  the  profession.  His 
wards  in  the  Glasgow  Royal  Infirmary  had  become 
the  healthiest  in  the  world. 

In  1869  Lister  was  called  to  Edinburgh  as  pro- 


346     THE  HISTORY  OF  MEDICINE 

fessor  of  clinical  surgery  on  the  retirement  of  Syme, 
and  at  first  found  himself  in  a  very  critical  atmos- 
phere. He  gave  in  his  first  lecture  a  history  of  the 
germ  theory,  referring  to  the  work  of  Schwann, 
Pasteur,  and  others.  He  had  repeated  Pasteur's 
experiment  in  which  putrescible  fluids  remained 
pure  in  the  presence  of  atmospheric  air,  and  he 
showed  to  his  audience  flasks  in  which  the  contents, 
kept  free  from  dust,  were  still  sweet  and  clear  after  a 
space  of  two  years.  As  Lister  said  in  later  life,  from 
the  beginning  of  his  campaign  in  favor  of  the  anti- 
septic method  he  had  the  youth  on  his  side.  He  was 
idolized  by  the  Edinburgh  students,  and  his  classes 
were  very  large.  The  poet  Henley,  who  was  one  of 
Lister's  patients  at  the  Royal  Infirmary,  has  ex- 
pressed in  a  sonnet  his  sense  of  the  surgeon's  influ- 
ence and  personality. 

THE  CHIEF 

His  brow  is  large  and  placid,  and  his  eye 

Is  deep  and  bright  with  steady  looks  that  still. 

Soft  lines  of  tranquil  thought  his  face  fulfill  — 

His  face  at  once  benign  and  proud  and  shy. 

If  envy  scout,  if  ignorance  deny 

His  faultless  patience,  his  unyielding  will, 

Beautiful  gentleness  and  splendid  skill, 

Innumerable  gratitudes  reply. 

His  wise,  rare  smile  is  sweet  with  certainties, 

And  seems  in  all  his  patients  to  compel 

Such  love  and  faith  as  failures  cannot  quell. 

We  hold  him  for  another  Heracles, 

Battling  with  custom,  prejudice,  disease, 

As  once  the  son  of  Zeus  with  Death  and  Hell. 


LORD   LISTER 


ANTISEPTIC  SURGERY  347 

At  Edinburgh,  where  Lister  spent  eight  years  in 
teaching,  practicing,  demonstrating  and  developing 
his  method  and  technique  (as  previously  at  Glas- 
gow, and  later  at  London),  surgeons  from  the  conti- 
nent appeared,  eager  to  sit  at  the  feet  of  the  master 
of  modern  scientific  surgery.  Dr.  Saxtorph,  profes- 
sor of  surgery  in  the  University  of  Copenhagen, 
visited  Edinburgh  in  the  summer  of  1869.  In  the 
following  year  he  wrote  to  Lister:  "Formerly  there 
used  to  be  every  year  several  cases  of  death  caused 
by  hospital  diseases,  especially  by  pyaemia,  some- 
times arising  from  the  most  trivial  injuries.  Now,  I 
have  had  the  satisfaction  that  not  a  single  case  of 
pyaemia  has  occurred  since  I  came  home  last  year, 
which  result  is  certainly  owing  to  the  introduction 
of  your  antiseptic  treatment." 

In  the  same  month  in  which  these  words  of  com- 
mendation were  written,  the  Franco- Prussian  War 
began.  The  Prussians  felt  convinced  that  the  sani- 
tary organization  of  their  armies  could  compete  with 
the  best  in  the  world.  A  large  medical  division  was 
provided,  which  on  occasion  could  be  broken  up  into 
smaller  units.  There  were  twelve  light  hospitals  for 
every  thirty  thousand  combatants.  Each  soldier 
carried  a  tin  of  dressings.  One  soldier  in  eight  had 
been  especially  trained  for  emergency  duties.  In- 
structions had  been  given  concerning  the  safety  of 
the  open  air  and  the  dangers  of  infection  in  crowded 


348     THE  HISTORY  OF  MEDICINE 

rooms.  Many  6*f  the  surgeons  were  aware  of  the 
antiseptic  value  of  carbolic  acid.  Lister's  treatment 
was,  however,  not  in  use;  though  he  published  at 
the  beginning  of  September,  1870,  a  brief  statement 
of  "A  method  of  antiseptic  treatment  applicable  to 
wounded  soldiers  in  the  present  war."  Stromeyer, 
who  has  been  called  the  father  of  modern  military 
surgery  in  Germany,  in  one  series  of  thirty-six  am- 
putations through  the  knee-joint  recorded  one  hun- 
dred per  cent  failures;  von  Nussbaum  amputated 
in  thirty-four  successive  cases  without  a  single  suc- 
cess. In  the  lower  limb  scarcely  an  amputation  re- 
covered, death  resulting  from  exhaustion,  sloughing 
of  the  flaps,  and  frequently  from  pyaemia.  Hospitals 
became  hotbeds  of  pyaemia  in  spite  of  what  had 
seemed  perfect  arrangements.  Among  the  French 
forces  conditions  were  much  worse.  Their  hospitals 
surpassed  in  horror  the  records  of  the  Crimean  War. 
Out  of  13,173  amputations  of  all  kinds,  including 
those  of  fingers  and  toes,  10,006  proved  fatal. 

Before  the  end  of  the  war,  von  Nussbaum  was  a 
convert  to  the  Lister  method.  In  the  years  following 
he  was  at  the  head  of  the  Allgemeines  Krankenhaus 
in  Munich.  It  was  overcrowded,  partly  on  account 
of  the  industrial  growth  of  the  city,  and  a  severe 
epidemic  of  hospital  gangrene  occurred.  In  1872, 
1873,  and  1874  the  percentage  of  wounded  or  oper- 
ated that  were  attacked  by  that  disease  —  to-day 


ANTISEPTIC  SURGERY  349 

almost  unknown  —  mounted  to  twenty-six,  to  fifty, 
to  eighty.  Von  Nussbaum  was  in  despair.  He  ap- 
pealed to  Lister  for  help,  and  dispatched  one  of  his 
assistants  to  Edinburgh  to  learn  the  antiseptic 
method.  It  was  soon  put  into  effect  at  Munich. 
Henceforth  hospital  gangrene  was  banished  from 
the  Allgemeines  Krankenhaus.  Von  Nussbaum's 
book,  with  an  account  of  the  antiseptic  treatment 
went  through  four  German  editions  in  six  years,  and 
was  translated  into  French,  Italian,  and  Greek. 
Thiersch  of  Erlangen  (later  of  Leipzig)  was,  how- 
ever, Lister's  first  disciple  among  the  surgeons  of 
Germany,  and  Richard  von  Volkmann  his  most  re- 
doubtable champion.  Von  Mikulicz-Radecki,  who 
was  Billroth's  assistant  at  Vienna,  was  sent  by  his 
master  to  visit  Lister  at  London  in  1879.  Lucas- 
Championniere,  the  French  pioneer  of  the  antiseptic 
method,  had  visited  Glasgow  as  early  as  1868;  and 
he  published  his  "Chirurgie  antiseptique "  in  1876. 
In  the  previous  year  Lister  in  response  to  urgent 
invitations  had  visited  a  number  of  German  uni- 
versity centers  —  Munich,  Leipzig,  Berlin,  Halle, 
and  Bonn.  According  to  the  "Lancet,"  his  progress 
through  Germany  took  on  the  character  of  a 
triumphal  march. 

While  the  antiseptic  treatment  was  making  rapid 
headway  throughout  Europe,  Lister  felt  that  he  still 
had  before  him  the  task  of  converting  his  native 


350     THE  HISTORY  OF  MEDICINE 

place  to  the  truth  of  the  new  doctrine.  The  oppor- 
tunity came  in  1877  when  he  was  invited  to  accept 
the  post  of  professor  of  clinical  surgery  in  King's 
College,  London.  He  reluctantly  consented  to  do  so. 
He  was  received  with  a  considerable  show  of  skepti- 
cism. He  and  those  who  had  accompanied  him  from 
Edinburgh  felt  helpless  for  a  time  in  facing  a  con- 
servatism and  inertia  that  seemed  hostile  to  every 
innovation.  In  about  a  month,  however,  a  patient 
appeared  who  had  broken  his  knee-cap.  Lister  cut 
down,  and  united  the  two  pieces  of  the  fractured 
patella  by  means  of  a  silver  wire.  He  operated  suc- 
cessfully in  cases  refused  by  the  leading  London  sur- 
geons. Some  who  had  been  set  up  as  his  rivals  and 
competitors  became  his  pupils  and  followers.  It  was 
soon  realized  that  through  the  introduction  of  the 
antiseptic  method  the  scope  of  surgery  was  greatly 
extended.  Both  in  London  and  elsewhere  operations 
on  the  brain,  as  well  as  on  the  thoracic  and  abdomi- 
nal viscera,  were  undertaken  with  ever-increasing 
freedom.  Orthopaedic  surgery  extended  its  range. 
Albrecht  von  Graefe,  the  most  famous  of  eye  sur- 
geons, recognized  the  added  power  that  came  from 
the  antiseptic  method.  Moreover,  surgeons  now 
took  courage  to  interfere  in  the  early  stages  of  an 
affection,  an  advantage  particularly  notable  in  the 
treatment  of  cancer. 

One  of  Lister's  old  students  at  London  writes 


•  •  P I  F Y  0  F 
ANTISEPTIC  SURGERY  351 

(1918),  in  answer  to  a  recent  critic:  "From  the  day 
of  Lister's  entry  we  never  saw  the  temperature  rise 
after  an  operation  in  any  of  his  patients,  and  never 
saw  a  blush  on  a  wound.  To  us  who  had  been 
taught  that  inflammation  was  necessary  for  heal- 
ing ...  it  was  a  miracle,  the  more  so  that  Lister 
immediately  did  operations  that  hitherto  we  had 
learned  must  always  prove  fatal."  It  is  true  that 
a  formidable  list  of  achievements,  some  preceding 
the  development  of  the  antiseptic  method,  may  be 
placed  to  Lister's  credit.  For  example,  in  1861  he 
described  an  original  amputation  in  the  neighbor- 
hood of  the  knee.  In  1862  he  recorded  the  successful 
use  of  a  tourniquet  of  his  own  invention  to  control 
the  abdominal  aorta.  In  1864  Syme  told  with  pride 
that  Professor  Lister  of  Glasgow  had  succeeded  in 
the  excision  of  the  wrist  for  caries.  In  1868  he  tested 
the  value  of  catgut  ligatures  by  tying  the  carotid 
artery  of  a  young  calf,  and  found  a  month  later 
(January,  1869)  that  the  ligatures  had  been  replaced 
by  living  tissue.  He  devoted  much  time  to  the  study 
of  ferments,  such  as  the  lactic  ferment,  and  the  rela- 
tion of  micro-organisms  to  the  blood;  and  came  to 
the  conclusion  about  1881  that  the  spray  of  car- 
bolic acid  solution,  which  he  had  long  used  in  his 
operating-room  to  destroy  the  pathogenic  organ- 
isms in  the  air,  was  not  essential  to  the  antiseptic 
method.  He  also  experimented  with  the  double  cya- 


352     THE  HISTORY  OF  MEDICINE 

nide  of  mercury  and  zinc  and  other  antiseptic  pre- 
parations. Nevertheless,  it  was  not  to  these  particu- 
lar achievements,  not  to  any  of  his  later  operations, 
such  as  the  excision  of  the  knee-joint,  that  Lister 
owed  his  fame,  but  to  the  steadfast  vigilance  with 
which  he  applied  a  great  principle. 

Lister  received  a  baronetcy  in  1883.  In  the  same 
year  he  visited  Austria  and  Hungary,  but  did  not 
hear  for  some  time  later  of  the  work  of  Semmelweiss, 
frequently  regarded  as  his  forerunner.  In  1892  he 
attended  the  Pasteur  jubilee  at  Paris  and  with  his 
usual  magnanimity  ascribed  all  his  own  triumphs  in 
surgery  to  the  work  of  the  founder  of  bacteriology. 
In  1895  he  became  President  of  the  Royal  Society. 
In  1896  he  was  chosen  President  of  the  British  As- 
sociation for  the  Advancement  of  Science,  and  in  the 
following  year  he  was  raised  to  the  peerage.  In  1902 
was  celebrated  the  fiftieth  anniversary  of  his  en- 
trance into  the  medical  profession.  At  a  banquet 
given  in  honor  of  Lord  Lister  by  the  Royal  Society, 
Mr.  Thomas  -Bayard,  the  American  Ambassador, 
addressing  the  great  surgeon,  said:  "My  Lord,  it  is 
not  a  profession,  it  is  not  a  nation,  it  is  humanity 
itself  which  with  uncovered  head  salutes  you." 
Lord  Lister  died  in  1912.  A  public  funeral  service 
was  held  in  Westminster  Abbey,  where  a  marble 
medallion  now  commemorates  him.  But,  in  accord- 
ance with  special  instructions  he  had  given,  he  was 


ANTISEPTIC  SURGERY  353 

V* 

buried  beside  his  wife  in  a  simple  tomb  in  the  West 
Hampstead  Cemetery. 

REFERENCES 

Allbutt,  Sir  Clifford  T.:  "Lord  Lister,"  Encyclopedia  Britannica. 

Bloch,  Oscar:  "Antiseptic  Treatment  of  Wounds,"  British  Medi- 
cal Journal,  1902,  pp.  1825-28. 

Cameron,  Sir  Hector:  "The  Evolution  of  Modern  Surgery," 
British  Medical  Journal,  1902,  pp.  1844-48. 

Jkxllee,  Sir  Rickman:  Lord  Lister.  1917.  676  pp. 

Lister,  Baron  Joseph :  Collected  Papers.  2  vols.    • 

Lucas-Championniere,  Just:  "An  Essay  on  Scientific  Surgery," 
British  Medical  Journal,  1902,  pp.  1819-21. 

Von  Mikulicz-Radecki,  Johann:  "Treatment  of  Fractured  Patel- 
la," British  Medical  Journal,  1902,  pp.  1828-31. 


CHAPTER  XVIII 
THE  HISTORY  OF  SYPHILIS 

THE  term  "syphilis"  was  first  used,  so  far  as  we 
know,  by  the  distinguished  Italian  physician  Fracas- 
toro,  who  in  1530  wrote  a  poem  "Syphilis  sive 
Morbus  Gallicus."  But  the  synonymous  expression 
and  its  many  equivalents  —  "French  pox,"  "Gal- 
lische  Krankheit,"  "mal  francese,"  etc. —  were 
extensively  used  before  the  close  of  the  fifteenth 
century,  and  were  soon  translated  into  some  of  the 
languages  of  Africa  and  Asia.  In  France  syphilis  had 
a  great  many  names,  but  only  one  of  these  had  any 
geographical  reference,  namely,  "mal  de  Naples," 
a  term  that  found  echoes  in  three  or  four  other  lan- 
guages. In  England  the  disease  was  called,  among 
other  things,  "Spanish  pox";  and  similar  expres- 
sions were  used  in  Scotland,  Holland,  Germany, 
and  in  the  western  part  of  North  Africa.  The  Rus- 
sians called  it  at  times  the  "Polish  disease";  and 
the  Persians  knew  it  as  the  "Turkish  disease."  The 
Portuguese,  turning  their  eyes  to  the  east  rather 
than  to  the  west,  spoke  of  the  "Castilian  disease." 
The  Spaniards,  however,  used  occasionally  the  term 
"Indian  measles,"  and,  also,  "disease  of  the  island 
of  Hispaniola"  (that  is,  Santo  Domingo). 


THE  HISTORY  OF  SYPHILIS       355 

There  was  a  fierce  epidemic  of  syphilis  in  Europe 
near  the  end  of  the  fifteenth  century.  Its  diffusion  is 
associated  with  the  military  expedition  in  Italy, 
under  the  leadership  of  Charles  VIII  of  France,  in 
1494  and  1495.  The  army  of  the  French  king,  made 
up  of  adventurers  from  various  countries,  and  ac- 
companied by  a  dissolute  train  of  camp-followers, 
met  with  little  opposition.  There  was  a  slight  en- 
gagement with  a  force  of  Spaniards  and  Neapolitans 
at  Rapallo  (near  Genoa)  in  September,  1494. 
Charles  halted  for  a  short  time  in  Florence  on  his 
triumphal  progress  south;  lingered  four  weeks  in 
Rome,  then  governed  by  Alexander  Borgia;  and 
entered  Naples  February  22,  1495.  Here  he  stayed 
for  about  three  months.  Some  historians  attribute 
the  epidemic  to  Spanish  mercenaries  in  the  army  of 
Charles;  others  put  it  down  to  the  Spaniards  in 
Naples,  which  had  for  some  time  been  a  possession 
of  the  House  of  Aragon,  and  particularly  to  the  gar- 
rison of  a  fortress  in  the  harbor,  who  held  out  for 
three  weeks  after  the  French  troops  had  entered  the 
city,  and  who  then  for  the  most  part  went  over  to 
the  service  of  Charles.  Professor  Robinson  men- 
tions as  one  of  the  momentous  results  of  this  cam- 
paign that  the  intellectual  leadership  of  Europe 
passed  from  Italy  to  England,  France,  and  Ger- 
many. However  that  may  be,  the  venereal  plague 
ran  within  a  few  months  through  the  Italian  cities, 


356     THE  HISTORY  OF  MEDICINE 

and  reached  the  borders  of  France,  Switzerland,  and 
Germany. 

There  is  evidence  to  show  that  syphilis  had  ap- 
peared along  the  line  of  march  in  1494,  that  is,  before 
Charles  had  reached  Naples,  namely,  in  the  camp  at 
Rapallo,  in  the  neighboring  city  of  Genoa,  and  in 
Rome.  It  developed  into  a  virulent  epidemic  at 
Naples  before  May,  1495,  and,  it  seems  reasonable 
to  suppose,  hastened  the  retirement  of  the  French 
northwards.  We  hear  of  its  breaking  out  in  1495  at 
Florence,  at  Bologna  (at  which  center  of  learning,  as 
elsewhere,  it  was  regarded  as  a  new  and  unheard-of 
disease),  at  Cremona,  Verona,  and  Novara,  where  a 
part  of  the  retreating  army  was  besieged  for  several 
months.  The  epidemic  seems  not  to  have  reached 
Modena,  Ferrara,  and  Venice  till  the  following  year. 
Syphilis  at  the  time  of  this  European  epidemic  was 
extremely  malignant,  a  fact  explained  by  Bloch,  who 
maintains  that  this  was  the  first  appearance  of  the 
disease  in  the  Old  World,  on  the  ground  that  it  here 
found  virgin  soil,  as  he  expresses  it.  The  secondary 
symptoms  appeared  very  early  —  often  in  a  few 
days;  the  patients  had  high  fever;  they  suffered 
intense  pains  (especially  in  the  joints)  and  severe 
skin  affections;  they  fell  into  general  decline,  and 
very  frequently  died. 

Charles  reached  Lyons  in  November,  1495,  but 
the  greater  part  of  his  forces,  after  leaving  Italy, 


THE  HISTORY  OF  SYPHILIS      357 

had  scattered  in  all  directions.  The  disease  was  soon 
prevalent  in  the  south  of  France,  and  by  the  be- 
ginning of  1497  had  become  so  general  that  the 
Parliament  of  Paris  issued  regulations  in  the  hope  of 
controlling  "la  grosse  verole,"  which  for  two  years 
had  afflicted  the  kingdom,  as  well  Paris  as  other 
places.  The  Emperor  Maximilian  I,  in  an  edict 
dated  August  7,  1495,  recognized  the  danger  for  his 
dominions  of  the  new  and  unheard-of  scourge.  Some 
of  his  troops  had  taken  part  with  the  enemies  of 
France  at  the  protracted  siege  of  Novara,  where  the 
epidemic  had  prevailed;  and  German,  Hungarian, 
and  Slav  mercenaries  had  formed  part  of  the  army  of 
Charles.  The  fact  that  six  thousand  Swiss  mercen- 
aries also  accompanied  the  French  accounts  for  the 
early  appearance  of  syphilis  in  Switzerland.  The 
disease  reached  Great  Britain  in  1497  from  French 
and,  probably,  Spanish  ports.  It  was  carried  to  the 
Netherlands  in  1496  by  the  retainers  of  a  Spanish 
princess.  It  appeared  in  Russia  in  1499  coming  by 
way  of  Poland.  The  latter  country  is  said  to  have 
got  the  infection  from  an  individual  woman,  who 
had  made  her  way  from  Rome  to  Cracow  as  early 
as  1495. 

When  we  turn  to  Spain,  we  find  new  light  is 
thrown  on  the  history  of  the  syphilis  epidemic  by 
the  evidence  of  reliable  witnesses.  The  most  impor- 
tant of  these  is  the  physician  Ruy  Diaz  de  Isla,  who 


358     THE  HISTORY  OF  MEDICINE 

at  the  age  of  thirty-one  was  practicing  at  Barcelona 
at  the  time  of  the  return  of  Columbus  from  the  West 
Indies  in  1493.  Before  1521  this  physician  wrote  a 
book  dedicated  to  the  King  of  Portugal  —  "Against 
the  Reptilian  Disease,  Commonly  Called  in  Spain 
the  Buboes."  The  first  chapter  deals  with  the  birth 
and  origin  of  the  disease  on  the  island  of  Hispaniola. 
He  states  that  it  made  its  appearance  in  Spain  in  the 
city  of  Barcelona  in  the  year  1493.  The  city  became 
infected,  and  from  it  all  Europe  and  all  the  known 
and  accessible  parts  of  the  earth.  It  had  its  birth 
and  origin  in  the  island  of  Hispaniola.  When  the 
island  had  been  discovered  by  the  Spaniards,  they 
had  had  intercourse  with  the  natives,  and  the  disease 
being  readily  contagious  it  presently  appeared  on 
the  ships.  At  the  time  Columbus  returned  to  Spain, 
Ferdinand  and  Isabella  were  in  the  city  of  Barce- 
lona, and  while  they  were  receiving  accounts  of  the 
voyage  and  the  discoveries  the  disease  began  to 
infect  the  people  and  to  spread  through  the  city. 
According  to  de  Isla  a  great  many  Spaniards  in- 
fected with  the  disease  joined  the  army  of  Charles  in 
the  following  year  and  thus  infected  the  main  body 
of  the  French  army.  The  Indians  of  Hispaniola 
called  the  disease  "Guaynaras,"  and  applied  other 
names  to  it.  As  for  the  physician's  own  name  for 
it,  he  considered  it  appropriate;  because  a  reptile 
is  a  hideous,  fearful,  and  dreadful  animal,  and  the 


THE  HISTORY  OF  SYPHILIS       359 

disease  is  likewise  hideous,  fearful,  and  dreadful. 
It  is  a  severe  disease,  forming  abscesses  and  cor- 
rupting the  flesh,  breaking  and  rotting  the  bones, 
and  shortening  and  drawing  up  the  sinews.  And, 
since  de  Isla  knew  that  the  disease  from  remote 
times  had  existed  in  Hispaniola,  whence  it  had 
spread  throughout  the  world,  he  called  it  the  rep- 
tilian disease  of  the  island  of  Hispaniola.  He  also 
insisted  that  the  disease  had  never  been  seen  and 
never  known  before  the  voyage  of  Columbus,  and 
that  nothing  like  it  could  be  found  described  in 
medical  works. 

De  Isla's  conviction  that  the  reptilian  disease  had 
existed  from  time  immemorial  on  the  island  of  His- 
paniola rested  on  the  fact  that  the  natives  had 
developed  a  complete  system  of  therapy  in  its  treat- 
ment —  the  use  of  guaiac,  balata,  and  other  vege- 
table remedies,  the  regulation  of  diet,  care  regarding 
water  and  air,  and  abstention  for  a  certain  time  from 
sexual  intercourse.  With  an  eye  on  the  difficulties 
experienced  in  his  own  time  by  civilized  peoples  in 
dealing  with  an  unknown  disease,  de  Isla  argued 
that  the  very  stupid  natives  of  Hispaniola  must 
have  known  guaynaras  for  very  many  generations 
before  arriving  at  their  clever  and  orderly  treatment 
of  it.  The  Spanish  physician  maintained  that  mer- 
cury was  the  only  reliable  remedy  for  the  reptilian 
disease  as  it  existed  in  Europe ;  he  employed  it  as  an 


360     THE  HISTORY  OF  MEDICINE 

inunction.  He  advocated  a  well  considered  plan  for 
the  state  control  of  syphilis.  Besides  his  experience 
in  treating  at  Barcelona  some  of  the  crew  accom- 
panying Columbus  (among  them  the  pilot  Vicente 
Pinzon),  as  well  as  other  people  in  the  city  infected 
with  the  disease,  de  Isla  saw  practice  at  Seville 
(where  Columbus  had  passed  four  weeks  or  more 
before  reaching  Barcelona),  and,  subsequently,  had 
served  many  years  in  All  Saints'  Hospital  at  Lisbon, 
where  he  had  abundant  opportunities  of  studying 
syphilis. 

The  American  origin  of  syphilis  is  likewise  upheld 
by  Oviedo,  the  author  of  the  "General  and  Natural 
History  of  the  Indies,"  who  crossed  the  Atlantic 
many  times,  spent  over  forty  years  in  America,  and 
was  particularly  well  acquainted  with  the  island  of 
Hispaniola.  As  a  boy  of  fifteen  he  had  been  present 
at  the  landing  of  Columbus  at  Barcelona,  where  he 
made  friends  with  the  sons  of  the  discoverer  and 
with  Vicente  Pinzon.  In  1501  Oviedo  spent  six 
months  in  Sicily  with  Gonsalvo  de  Cordova,  who  in 
1495  had  been  sent  from  Spain  with  an  army  to 
oppose  Charles  VIII,  and  whose  secretary  Oviedo 
became  in  1512.  On  a  visit  to  Italy  the  young  man 
was  much  amused  to  hear  that  the  Italians  called 
syphilis  "mal  francese"  and  that  the  French  called 
it  "mal  napolitain,"  for  he  was  well  aware  it  should 
be  called  "mal  de  las  Indias."  According  to  him 


THE  HISTORY  OF  SYPHILIS       361 

some  of,the  companions  of  Columbus  had  become 
infected  at  the  time  of  the  first  voyage  to  America, 
and,  after  their  return  to  Spain,  the  infection  passed 
to  Italy  and  other  countries.  It  had  not  been  known 
in  Spain  until  the  return  of  Columbus  in  1493. 
Immediately  it  had  spread  among  the  lower  classes, 
and  later  had  found  its  way  among  the  gentry  and 
nobility.  Oviedo  knew  that  some  of  the  soldiers 
under  the  command  of  Gonsalvo  de  Cordova  in 
1495  were  infected  before  quitting  Spain. 

Oviedo  believed  that  syphilis  was  found  not  only 
in  Hispaniola,  but  throughout  the  West  Indies  and 
on  the  American  mainland.  It  was  less  dangerous, 
he  said,  in  those  regions  than  in  Spain  and  the  other 
countries  of  the  Old  World.  The  Indians  knew  how 
to  cure  it  by  the  use  of  guaiac  (which  was  fresher  and 
consequently  more  efficacious  in  the  Indies  than  in 
Europe),  and  other  vegetable  remedies.  Of  the 
Christians  who  had  intercourse  with  the  native 
women  few  escaped  with  impunity. 

The  statements  of  Oviedo  in  reference  to  the 
comparative  mildness  of  the  disease  among  the 
American  natives  and  the  marked  susceptibility  of 
Europeans  to  the  infection  are  fully  corroborated 
by  Las  Casas,  known  as  "the  Apostle  of  the  Indies," 
who  also  refers,  like  Oviedo  and  de  Isla,  to  the  suc- 
cess of  the  native  therapy.  Moreover,  he  is  able 
to  support  by  the  testimony  of  the  aborigines  the 


362     THE  HISTORY  OF  MEDICINE 

theory  of  de  Isla  regarding  the  antiquity  of  the 
disease  in  the  island  of  Hispaniola.  He  took  great 
pains,  he  says,  to  question  the  Indians  as  to  whether 
the  disease  had  long  existed  on  the  island.  They 
answered  in  the  affirmative;  it  had  been  present  so 
long  among  them  before  the  coming  of  the  Chris- 
tians that  there  was  no  memory  of  its  beginning. 
Of  the  truth  of  this,  Las  Casas  felt  there  could  be  no 
doubt.  Indeed,  we  know  from  other  sources  that  the 
presence  of  guaynaras  in  Hispaniola  was  implied  in 
the  earliest  traditions  of  the  natives. 

Las  Casas  was  born  in  Seville  in  1474.  His  father 
accompanied  Columbus  in  1492,  and  the  young  man 
was  present  when  the  discoverers  in  1493  brought 
ten  Indians  from  Hispaniola  to  Seville,  where  they 
remained  for  about  a  month  before  proceeding  to 
Barcelona.  He  went  to  the  West  Indies  in  1498,  and 
was  ordained  as  a  priest  in  1510  on  the  island  of 
Hispaniola,  where  he  passed  altogether  twenty  years 
of  his  life.  He  was  appointed  Bishop  of  Chiapa, 
Mexico,  in  1543.  He  lived  to  the  age  of  ninety-two, 
and  left  a  manuscript  "History  of  the  Indies."  In 
the  judgment  of  this  well-informed  witness  the 
disease  known  to  the  Italians  as  "mal  francese" 
was  carried  to  Europe  by  the  Indians  Columbus 
took  to  Spain  in  1493  or  by  the  Spaniards  who  had 
been  infected  in  Hispaniola  at  the  time  of  its  dis- 
covery. 


THE  HISTORY  OF  SYPHILIS        363 

As  regards  the  epidemic  in  Barcelona,  following 
the  return  of  Columbus  from  his  first  voyage  to  the 
West  Indies,  we  have  valuable  corroborative  evi- 
dence in  a  letter  written  in  June,  1495  (printed  in 
the  following  March),  by  the  Sicilian  physician 
Nicol6  Scillaccio.  The  letter  is  addressed  to  his 
former  teacher  at  Pavia,  Ambrogio  Rosato,  physi- 
cian to  Ludovico  Sforza  (who  a  few  months  later 
overcame  the  French  resistance  at  Novara).  Scil- 
laccio had  left  Italy  for  Spain  in  February,  unaware 
of  the  imminent  epidemic.  It  is  with  some  gusto  he 
announces  to  his  master  the  advent  of  a  new  disease. 
Among  the  symptoms  he  had  observed  in  those 
infected  in  Barcelona  were  purulent  pustules,  in- 
tense fever,  arthritis  with  severe  pains,  dermal 
crusts,  and  swellings  colored  at  first  blue  and  later 
blackish.  The  disease  begins  most  frequently  in  the 
genitals,  but  spreads  to  the  whole  body.  According 
to  the  statement  of  Scillaccio  this  new  species  of 
malady  had  but  recently  invaded  Spain.  The 
disease  does  not  run  longer  than  a  year  in  an  indi- 
vidual case  (annum  morbus  non  excedif}.  This  state- 
ment gives  us  reason  to  affirm  that  it  had  been 
under  observation  in  Barcelona  for  a  year  or  two. 

According  to  Osier,  "writers  who  contend  for  the 
antiquity  of  the  disease  in  Asia  and  Europe  rely  on 
certain  old  Chinese  records,  on  references  in  the 
Bible  and  in  old  medical  writers  to  diseases  resem- 


364     THE  HISTORY  OF  MEDICINE 

bling  syphilis  and  on  suggestive  bone  lesions  in  very 
old  skeletons.  The  balance  of  evidence,  according 
to  the  best  syphilographers,  is  in  favor  of  the  Amer- 
ican origin."  No  European  bones  belonging  to  a 
date  earlier  than  1493  show  satisfactory  indications 
of  the  disease ;  though  skeletons  belonging  to  a  later 
period  have  been  found  with  the  characteristic  signs 
wherever  the  infection  has  been  carried  —  even  in 
regions  so  remote  from  Europe  as  the  Philippines, 
New  Caledonia,  and  Australia.  In  America,  on  the 
other  hand,  this  sort  of  negative  evidence  is  not  so 
decisive.  For  example,  two  skulls  have  been  found 
in  Tennessee,  one  of  which  shows  signs  of  syphilitic 
caries,  the  other  the  thickening  of  the  nasal  bones 
indicative  of  syphilis.  Their  discoverer  thought 
them  probably  the  most  ancient  syphilitic  bones  in 
the  world.  It  is  not  positively  known,  however, 
that  they  belong  to  the  pre-Columbian  period. 

The  outbreak  of  syphilis  in  Europe  at  the  end  of 
the  fifteenth  century  was  a  challenge  to  the  medical 
science  of  the  time.  The  problems  it  raised  could 
not  be  answered  by  consulting  the  volumes  of  Galen 
and  his  commentators.  Its  extreme  virulence  seems 
to  have  prevented  its  early  observers  from  confusing 
it  with  gonorrhoea.  Berengario  da  Carpi  treated  it 
with  inunctions  of  mercury  as  early  as  1500,  and, 
therefore,  disputes  with  Diaz  de  Isla,  the  honor  of 
introducing  this  form  of  treatment.  Before  the 


THE  HISTORY  OF  SYPHILIS       365 

middle  of  the  sixteenth  century  Mattioli  employed 
mercury  internally.  Mercurial  plasters  came  into 
use,  as  well  as  fumigations,  sulphur  baths,  and 
guaiacum.  Sarsaparilla,  which  had  been  used  in 
America  in  the  treatment  of  syphilis,  was  used  by 
the  Portuguese  even  on  the  coast  of  India  as  early 
as  I535-  In  addition  to  the  symptoms  already  re- 
ferred to,  the  physicians  of  the  sixteenth  century 
took  note  of  the  primary  lesion,  the  falling  out  of  the 
hair,  affections  of  the  internal  organs,  and  disorders 
of  the  nervous  system.  Paracelsus  recorded  the 
observation  of  congenital  syphilis.  The  venereal 
nature  of  the  disease  and  its  special  mode  of  trans- 
mission were  soon  generally  recognized,  and  in  1557 
Fernel  stated  definitely  that  the  disease  always  gave 
rise  to  a  little  sore  and  pustule  at  the  point  of  the 
primary  inoculation.  Pare  noted,  as  we  have  seen, 
the  connection  between  aneurism  and  syphilis,  and 
wrote  in  detail  concerning  hereditary  syphilis. 

After  the  beginning  of  the  seventeenth  century 
there  was  a  clearer  recognition  of  the  minor  causes  of 
infection  —  the  communication  of  the  disease  to 
physicians  and  midwives  by  lying-in  women,  infec- 
tion from  drinking-vessels,  inoculation  by  kissing, 
and  the  transmission  of  the  disease  through  the 
operation  of  cupping,  the  infection  of  the  child  by 
the  nurse  and  of  the  nurse  by  the  child.  The  list  of 
syphilitic  affections  was  gradually  increased  — 


366     THE  HISTORY  OF  MEDICINE 

chancre  of  the  tonsil,  nasal  syphilis,  lesions  of  larynx, 
windpipe,  and  lungs,  gummata  of  the  brain,  syphili- 
tic neuralgias,  and  diseases  of  the  spinal  cord.  As 
we  have  seen  in  the  seventh  chapter,  Sydenham 
noted  the  lessened  virulence  of  the  disease  in  the 
seventeenth  century  as  gauged  by  the  records  of 
the  end  of  the  fifteenth  century,  held  that  this 
species  of  disease  is  not  immutable,  attempted  to 
trace  the  stages  passed  through  in  individual  cases, 
and  considered  syphilis  identical  with  yaws. 

In  the  eighteenth  century  Lancisi  described  car- 
diac syphilis,  and  supported  the  observations  of 
Par6  by  giving  syphilis  as  one  of  the  causes  of  aneu- 
rism. We  have  seen  in  the  ninth  chapter  that  Mor- 
gagni  held  syphilis  to  be  not  only  one  of  the  causes 
but  the  preponderating  cause  of  aneurism,  that  he 
had  observed  syphilitic  lesions  in  nearly  all  of  the 
thoracic  and  abdominal  viscera  and  believed  that 
venereal  disease  might  vitiate  any  viscus  whatever. 
"At  last,  John  Hunter  came  and  laid  the  true  foun- 
dations of  the  science  of  venereal  affections" 
(Ricord).  It  is  true  that  Hunter,  in  spite  of  his 
numerous  post-mortems,  failed  to  observe  syphilis 
of  the  viscera,  and  that  he  confused  syphilis  and 
gonorrhoea;  but  he  based  his  generalizations  in  this 
field,  as  elsewhere,  on  observation  and  experimenta- 
tion, and  had  the  courage  to  inoculate  himself  with 
venereal  virus  and  to  study  the  results  over  a  long 


THE  HISTORY  OF  SYPHILIS      367 

period  before  knocking  the  disease  down  with  mer- 
cury, as  he  expressed  it.  It  is  not  improbable  that 
this  was  the  cause  of  the  angina  pectoris  from  which 
he  suffered  for  many  years  and  which  resulted  in  his 
death.  As  mentioned  in  the  eighth  chapter  he  suc- 
ceeded in  differentiating  Hunterian  chancre  from 
chancroid  ulcer.  Before  the  end  of  the  eighteenth 
century  Benjamin  Bell  taught  that  there  is  a  differ- 
ence between  the  virus  of  gonorrhcea  and  that  of 
syphilis. 

At  the  beginning  of  the  nineteenth  century  Her- 
nandez confirmed  the  views  of  Bell  by  inoculating 
with  the  poison  of  gonorrhoea  seventeen  convicts  at 
Toulon.  Hunter  and  Hernandez  in  their  resort  to 
experiment  in  investigating  venereal  disease  may  be 
regarded  as  forerunners  of  Philippe  Ricord  (1800- 
89)  who  in  the  years  1831  to  1837  made  at  Paris 
twenty-five  hundred  inoculations,  and  proved  that 
gonorrhceal  secretion  never  produces  chancre  nor 
constitutional  syphilis.  He  established  the  three 
stages  of  syphilis,  held  that  the  induration  of  the 
chancre  is  subsequent  to  the  passage  of  the  poison 
into  the  general  system,  and  that  in  its  third  stage 
the  disease  is  non-communicable.  Virchow,  as 
already  stated  in  the  thirteenth  chapter,  set  forth 
in  detail  the  pathology  of  syphilis.  In  considering 
the  various  phases  of  the  subject  he  of  course  did  not 
overlook  the  histological.  He  noted,  for  example, 


368     THE  HISTORY  OF  MEDICINE 

the  resemblance  of  the  indurated  chancre  to  all 
gummatous  formations.  He  observed  that  a  syphil- 
itic cicatrice  in  the  bones  of  the  cranium  gives  evi- 
dence of  a  diminished  growth  in  the  center  and  an 
increased  growth  in  the  periphery.  This  and  other 
indications  of  syphilis  he  maintained  are  not  to  be 
found  in  skeletons  of  a  date  earlier  than  the  closing 
years  of  the  fifteenth  century.  Further  advances  in 
the  knowledge  of  venereal  disease  followed  the 
development  of  the  science  of  bacteriology.  Neis- 
ser's  discovery  of  the  micro-organism  of  gonorrhoea 
in  1879,  Ducrey's  isolation  of  the  bacillus  of  vene- 
real ulcer  in  1889,  and  the  success  of  Metchnikoff 
and  Roux  in  inoculating  monkeys  with  syphilis  in 
I903i  cleared  the  way  for  the  discovery  by  Fritz 
Schaudinn  in  1905  of  the  protozoon  Treponema  palli- 
dum  as  the  cause  of  syphilis. 

Schaudinn  (1871-1906),  born  at  a  small  place  in 
East  Prussia,  received  his  training  as  a  zoologist  at 
Berlin,  attaining  the  doctorate  at  the  age  of  twenty- 
three.  Four  years  later  he  was  an  instructor  in  his 
specialty,  and  in  1904  he  was  engaged  at  the  Im- 
perial Health  Bureau  as  an  expert  in  protozoology. 
Under  the  auspices  of  this  institution  he  pursued 
investigations  at  Rovigno  on  the  Istrian  coast.  In 
the  year  of  his  death  he  accepted  an  appointment 
in  the  Institut  fur  Schiffs-  und  Tropen-hygiene  at 
Hamburg.  He  studied  the  hookworm  recognized  as 


THE  HISTORY  OF  SYPHILIS       369 

the  cause  of  anaemia  among  the  miners  of  West- 
phalia, and  confirmed  the  discovery  of  Looss  in  refer- 
ence to  the  life-history  of  that  parasite.  Schaudinn 
made  important  contributions  to  the  classification 
of  protozoa  (such  as  Spirochata  and  Trypanosoma) 
as  well  as  their  mode  of  reproduction,  including  the 
mechanism  of  cell-division.  Although  he  had  not 
studied  medicine,  the  control  of  disease  soon  became 
one  of  the  main  purposes  of  his  work  in  science.  He 
insisted  on  the  necessity  of  knowing  the  complete 
history  of  microscopic  parasites,  and  traced  satis- 
factorily the  life  cycles  of  a  number  of  pathogenic 
protozoa  that  infest  man  and  the  lower  animals, 
such  as  Plasmodium  vivax  (the  relation  of  which  to 
the  human  blood-vessels  he  established)  and  Try- 
panosoma noctuce.  He  distinguished  Entomoeba  his- 
tolitica  from  Entomceba  coli.  Moreover,  he  estab- 
lished a  method  of  studying  protozoan  infections 
which  helped  to  guide  the  investigations  of  others. 
Five  years  after  Schaudinn  had  determined  the 
causative  agent  of  syphilis,  Ehrlich  announced  the 
discovery  of  a  specific. 

Paul  Ehrlich  (1854-1915)  was  born  at  Strehlen, 
Silesia;  received  his  early  education  in  his  native 
place  and  in  the  neighboring  city  of  Breslau;  after 
spending  a  semester  at  the  University  of  Breslau, 
proceeded  to  Strassburg,  where  he  began  the  study 
of  medicine;  and  later  visited  as  a  student  at  two 


370     THE  HISTORY  OF  MEDICINE 

other  German  universities.  He  took  advantage  of 
the  freedom  of  German  university  life  and  pursued 
intensively  those  studies  that  laid  claim  on  his 
interest.  Although  at  Strassburg  he  had  the  privi- 
lege of  the  instruction  of  Julius  Cohnheim,  Ehrlich 
was  more  influenced  by  Carl  Weigert,  his  cousin, 
with  whom  he  was  closely  associated.  He  was  soon 
distinguished  for  his  contributions  to  haematology, 
based  on  improved  methods  of  staining.  In  1882 
he  employed  fuchsin  red  in  staining  tubercle  bacilli. 
His  investigations  were  early  guided  by  the  hy- 
pothesis that  the  molecules  of  living  tissue  combine 
with  foods,  poisons,  dyes,  and  other  chemicals  by 
virtue  of  selective  affinities.  In  1885  he  reached  the 
conclusion  that  cell  protoplasm  takes  up  oxygen  as 
benzene  takes  up  bromine.  That  is,  the  elements  of 
the  protoplasm  that  enter  into  combination  with  the 
extraneous  molecules  are  analogous  to  the  side-chain 
of  the  benzene  ring.  In  1886  he  injected  methylene 
blue  in  the  blood  of  a  rabbit  and  discovered  that  the 
nervous  tissue  has  a  special  affinity  for  that  particu- 
lar dye.  In  1891  the  phenomena  of  immunity  of 
mice  to  gradually  increased  quantities  of  vegetable 
poison  gave  Ehrlich  ground  for  the  extension  of  his 
principles.  By  the  exercise  of  what  he  called  his 
"chemical  imagination"  he  pictured  a  poisonous 
substance  as  made  up  of  two  kinds  of  parts,  the 
actual  carriers  of  the  poison,  or  toxophores,  and  the 


THE  HISTORY  OF  SYPHILIS       371 

effecters  of  the  connection  with  the  protoplasm,  or 
haptophores.  When  the  poison  is  administered  in 
small  quantities,  the  side-chain  elements  —  chemo- 
receptors  —  of  the  protoplasm  break  away  from  the 
ring  and  render  the  toxin  harmless  by  combining 
with  the  haptophore.  At  the  same  time  the  proto- 
plasm is  stimulated  to  produce  a  very  great  number 
of  chemo-receptors,  which  neutralize  the  poison 
when  administered  in  larger  quantities.  Ehrlich  on 
the  basis  of  further  experiments  eventually  estab- 
lished an  international  standard  for  the  administra- 
tion of  diphtheria  antitoxin. 

The  fact  that  pathogenic  micro-organisms  share 
with  the  living  tissues  of  the  human  body  the  prop- 
erty of  combining  with  certain  chemical  substances, 
as  their  specific  affinity  for  certain  aniline  dyes 
bears  witness,  suggested  means  for  their  destruction. 
The  pathogenic  protozoa  revealed  by  the  micro- 
biological studies  of  Schaudinn  and  others  offered  a 
special  field  for  a  therapy  based  on  micro-chemistry. 
Ehrlich  had  something  of  Sydenham's  faith  regard- 
ing the  discovery  of  specifics.  Quinine  is  a  specific 
for  a  disease  caused  by  a  protozoan.  We  must  learn 
to  destroy  all  pathogenic  protozoa  without  injuring 
the  tissues  of  the  patient.  The  ideal  was  a  therapia 
sterilisans,  one  injection  of  which  would  destroy  all 
the  microbes,  which,  otherwise,  might  become  im- 
mune to  the  poisonous  influence  of  the  injected 


372     THE  HISTORY  OF  MEDICINE 

chemical  substance.  In  trypan  red  Ehrlich  discov- 
ered such  a  specific  for  sleeping  sickness  in  mice. 
This  is,  of  course,  a  trypanosome  disease.  In  1894 
Thomas  and  Breinl,  of  the  Liverpool  School  of  Trop- 
ical Medicine,  had  discovered  that  injections  of 
atoxyl  destroy  the  parasite  in  human  beings  suffer- 
ing from  sleeping  sickness.  It  was  found,  however, 
that  there  are  grave  objections  to  its  administration. 
Atoxyl  was  found  to  be  para-amino-phenylarsenic 
acid,  and  Ehrlich  discovered  (as  he  thought)  in  one 
of  its  derivatives  —  arsenophenylglycin  —  a  remedy 
for  all  trypanosomiases.  Would  one  of  these  com- 
plex arsenic  compounds  prove  effective  against  Tre- 
ponema  pallidum,  the  protozoon  of  syphilis?  After 
a  long  series  of  experiments  carried  out  by  Ehrlich 
and  his  Japanese  assistant  Hata  a  specific  was 
found  in  "606"  —  Salvarsan,  or  dioxydiamido  ar- 
senobenzol.  The  discovery  was  announced  in  the 
early  part  of  1911.  It  is  interesting  to  note,  in  con- 
nection with  the  conjecture  of  Sydenham  regarding 
the  identity  of  syphilis  and  yaws,  that  "606"  acts 
as  an  ideal  remedy  in  the  latter  disease,  which  is 
caused  by  a  parasite  —  Treponema  pertenue  — 
hardly  distinguishable  from  Treponema  pallidum. 

The  veteran  Sir  Jonathan  Hutchinson  (1828- 
1913),  who  had  seen  over  a  million  cases  of  syphilis, 
wrote  shortly  before  his  death:  "For  the  student  of 
pharmacology  syphilis  has  many  important  lessons. 


THE  HISTORY  OF  SYPHILIS      373 

The  marvel  which  we  witness  in  the  certain  and 
speedy  disappearance  under  the  influence  of  mer- 
cury of  a  large  sclerosis  as  hard  as  cartilage,  is  more 
than  equalled  by  the  melting  away  of  a  big  tumour- 
gumma  under  that  of  iodide  of  potassium."  The 
record  of  Hutchinson  and  others  may  serve  to 
remind  us  that  the  successful  treatment  of  syphilis 
had  its  beginnings  before  the  advent  of  recent 
chemotherapy. 

REFERENCES 

Bloch,  I  wan:  Der  Ur  sprung  der  Syphilis.  2  vols.,  1901. 

Also  a  brief  history  of  syphilis  in  Power  and  Murphy's 
System  of  Syphilis,  vol.  I,  1914,  pp.  3-39. 

Brown,  H.  M.:  Must  the  History  of  Syphilis  be  Rewritten?  Bull. 
Soc.  Med.  Hist.,  Chicago,  1917,  II,  pp.  1-14. 

Calkins,  Gary  N.:  "Fritz  Schaudinn,"  Science,  N.S.,  vol.  XXTV 
(1906),  pp.  154-55- 

Montgomery,  T.  H.,  Jr.:  "Fritz  Schaudinn,"  Popular  Science 
Monthly,  vol.  70  (1906),  pp.  274-78. 

Sudhoff,  Ka'rl:  The  Origin  of  Syphilis,  and  The  End  of  the  Fable 
of  the  Great  Syphilis  Epidemic  in  Europe  following  the  Dis- 
covery of  the  Antilles  (translations  by  A.  Allemann),  Bull. 
Soc.  Med.  Hist.,  1917,  n,  pp.  15-26. 
See  also  obituary  notice  of  Paul  Ehrlich  in  the  Proceedings  of 

the  Royal  Society,  series  B,  vol.  92  (1921),  pp.  i-vii. 


CHAPTER  XIX 
PREVENTIVE  MEDICINE  IN  THE  TROPICS 

MORE  than  a  century  before  the  appearance  of 
syphilis  in  Europe  the  eastern  hemisphere  was  rav- 
aged by  another  disease  which  had  its  origin  in  the 
tropics.  The  Black  Death,  or  Plague,  which  even 
since  the  beginning  of  the  twentieth  century  has 
carried  off  millions  of  the  inhabitants  of  India,  in 
the  fourteenth  swept  to  the  northwest  and  claimed 
about  sixty  million  victims.  This  was  not  its  first 
nor  its  last  visitation  of  Europe.  We  have  already 
seen  its  disastrous  effects  in  London  and  elsewhere 
in  the  time  of  Sydenham ;  and  within  the  last  twenty- 
five  years  this  dreaded  disease  has  threatened  the 
ports  of  Italy,  France,  Germany,  and  Great  Britain, 
as  well  as  those  of  America  both  on  the  Atlantic  and 
the  Pacific.  The  virulent  outbreak  at  Hong- Kong  in 
1894  led  to  the  study  of  the  pestilence  in  the  light 
of  modern  bacteriology  and  parasitology/  Within  a 
few  months  Kitasato  and  Yersin  had  discovered  the 
Bacillus  pestis.  Of  the  two  forms  of  the  disease  — 
the  pneumonic  and  the  bubonic  —  the  former  may 
be  conveyed  from  one  person  to  another  by  means  of 
bacilli  borne  by  the  air.  Bubonic  plague  is  trans- 
mitted to  man  from  the  rat  by  fleas.  The  chief 


PREVENTIVE  MEDICINE          375 

preventive  measure  is  the  extermination  of  diseased 
rats.  Haffkine's  prophylactic  vaccine  has  a  marked 
effect  both  in  decreasing  the  chances  of  infection  and 
in  increasing  the  chances  of  recovery  in  cases  in 
which  infection  takes  place. 

It  was  Dr.  (afterwards  Sir  Patrick)  Manson  who 
prepared  the  way  for  the  greatest  triumphs  of  pre- 
ventive medicine  in  the  tropics  by  demonstrating 
thoroughly,  in  1879,  that  the  mosquito  is  the  inter- 
mediate host  of  Filaria  sanguinis  hominis,  the  para- 
site in  certain  particularly  hideous  forms  of  filariasis. 
Manson  traced  the  life-cycle  of  the  nematode  in  the 
mosquito  and  in  the  definitive  host,  man.  He  ob- 
served the  filariae  in  the  stomach  of  the  mosquito 
after  it  had  sucked  the  blood  of  a  patient  suffering 
from  filariasis,  found  that  within  a  few  hours  they 
broke  down  the  blood  corpuscles  in  the  abdomen 
of  the  insect,  the  escape  of  the  haemoglobin  bringing 
about  a  thickening  of  the  plasma.  The  viscosity  of 
the  plasma  seemed  to  stimulate  the  filariae  to  wriggle 
out  of  their  sheaths.  Once  rid  of  these  they  moved 
about  freely  and  found  their  way  into  the  thoracic 
muscles  of  the  mosquito,  where  they  underwent 
metamorphosis,  the  young  parasites  showing  a 
remarkable  increase  in  size.  The  mosquito,  about  a 
week  after  sucking  the  blood  of  the  filariasis  patient, 
lays  her  eggs  on  the  surface  of  stagnant  water,  and 
then  dies.  The  filariae  find  their  way  into  the  water 


376     THE  HISTORY  OF  MEDICINE 

from  the  dead  body  of  the  intermediate  host,  and 
thence  into  the  stomach  of  the  definitive  host,  and 
from  the  stomach  reach  the  lymphatic  trunks. 
There  they  attain  sexual  maturity,  and  give  birth 
to  a  new  generation  of  filariae,  which  eventually  pass 
by  way  of  the  lymphatic  vessels  into  the  blood 
stream. 

In  the  year  following  Manson's  discovery  of  the 
life-history  of  Filaria  sanguinis  hominis,  Alphonse 
Laveran,  a  French  army  surgeon  on  service  in 
Algeria,  observed  in  the  blood  of  patients  suffering 
from  malaria  parasites  which  he  considered  the 
cause  of  the  disease,  a  judgment  that  was  soon  con- 
firmed by  Dr.  Richard  and  others.  These  protozoa 
were  accurately  described  by  Marchiafava  and  Celli 
in  1885.  There  are  three  varieties  of  this  group 
of  haemocytozoa,  Plasmodium  vivax,  Plasmodium 
malaria,  and  Plasmodium  falciparum,  the  parasites 
respectively  of  tertian,  quartan,  and  sestivo-autum- 
nal  fevers.  Golgi,  the  histologist,  who  as  early  as 
1885  had  shown  that  the  paroxysms  of  malarial 
patients  occur  at  the  same  time  as  the  sporulation 
of  the  parasites,  took  the  first  step  (1889)  toward 
establishing  the  relationship  between  the  varieties 
of  the  parasite  and  the  various  forms  of  malarial 
fever.  Golgi 's  discovery  of  the  coincidence  between 
the  malarial  paroxysms  of  the  patient  and  the  sporu- 
lation of  Plasmodia  was  confirmed  by  Dr.  (after- 


PREVENTIVE  MEDICINE         377 

wards  Sir  William)  Osier,  while  the  task  of  determin- 
ing the  exact  casual  relationship  between  pernicious, 
tertian,  and  quartan  fever  on  the  one  hand,  and  P. 
falciparum,  P.  vivax,  and  P.  malaria  on  the  other 
hand,  was  immediately  completed  by  Marchiafava 
and  Celli. 

In  1886  Dr.  G.  M.  Sternberg  directed  the  atten- 
tion of  the  medical  profession  in  the  United  States 
to  the  views  of  Laveran  concerning  the  etiology  of 
malaria,  and  these  soon  gained  support  from  the 
investigations  of  Councilman,  Abbott,  Thayer,  and 
others,  including  Osier.  As  early  as  1883  Dr.  A.  F. 
A.  King  had  put  forward  as  worthy  of  observation 
and  experiment  the  supposition  that  mosquitoes 
(rather  than  marsh  vapor)  are  the  source  of  malarial 
infection.  In  1889  Theobald  Smith  demonstrated 
that  Texas  fever  is  caused  in  cattle  by  a  haematozoan 
parasite,  later  (1893)  shown  to  be  carried  by  an 
insect.  It  remained  for  Manson  to  formulate  a 
definite  verifiable  hypothesis  concerning  the  relation 
of  the  mosquito  to  the  malaria  parasite.  With  his 
studies  of  filaria  in  mind  he  proceeded  on  the  sup- 
position that  the  protozoa,  after  undergoing  sexual 
reproduction,  complete  their  life-cycle  in  the  body 
of  an  insect  host.  Laveran  had  observed  in  the  blood 
of  malarial  patients  withdrawn  from  the  circulation 
that  some  of  the  gametocytes  put  forth  motile  fila- 
ments. These  processes,  mistaken  by  Manson  for 


378  .  THE  HISTORY  OF  MEDICINE 

spores  (and  later  shown  to  be  of  the  nature  of 
spermatozoa),  he  correctly  supposed  to  play  an 
essential  part  in  maintaining  the  life  of  the  protozoa 
in  the  body  of  some  suctorial  insect.  In  1894  Man- 
son  communicated  his  hypothesis  to  Major  (now 
Sir)  Ronald  Ross,  who  undertook  its  verification  in 
the  malarial  districts  of  India,  where  he  was  on 
service. 

This  was  a  very  difficult  task;  for  the  species  of 
mosquito  that  might  prove  the  intermediate  host  of 
the  protozoon  and  the  form  the  latter  might  bear  in 
the  body  of  the  insect  were  alike  unknown  at  that 
time.  Ross,  in  the  course  of  an  investigation  extend- 
ing about  two  and  a  half  years,  fed  hundreds  of  mos- 
quitoes of  different  species  on  persons  suffering  with 
malarial  fever,  and  then  examined  the  tissues  of 
each  insect  in  the  hope  of  discovering  the  parasite. 
As  he  stated  in  1900,  "nothing  but  the  most  con- 
vincing theory,  such  as  Manson's  theory  was, 
would  have  supported  or  justified  so  difficult  an 
enterprise."  Finally  eight  mosquitoes  of  a  species 
with  spotted  wings  were  fed  on  a  malarial  patient. 
On  dissecting  the  seventh  of  these  specimens  the 
investigator  achieved  his  first  success. 

"The  tissues  of  the  stomach  (which  was  now 
empty  owing  to  the  meal  of  malarial  blood  taken  by 
the  insect  four  days  previously  being  digested)  were 
reserved  to  the  last.  On  turning  to  this  organ  I  was 


PREVENTIVE  MEDICINE          379 

struck  by  observing,  scattered  on  its  outer  surface, 
certain  oval  or  round  cells  of  about  two  or  three 
times  the  diameter  of  a  red  blood  corpuscle  —  cells 
which  I  had  never  seen  in  the  hundreds  of  mosqui- 
toes examined  by  me.  My  surprise  was  complete 
when  I  next  detected  within  each  of  these  cells  a  few 
granules  of  the  characteristic  coal-black  melanin  of 
malarial  fever  —  a  substance  quite  unlike  anything 
usually  found  in  mosquitoes.  Next  day  the  last  of 
the  remaining  spotted-winged  insects  was  dissected. 
It  contained  precisely  similar  cells,  each  of  which 
possessed  the  same  melanin;  only  the  cells  in  the 
second  mosquito  were  somewhat  larger  than  those  in 
the  first.  .  .  . 

"These  fortunate  observations  solved  the  malarial 
problem.  As  a  matter  of  fact  the  cells  were  the 
zygotes  of  the  parasite  of  remittent  fever  growing  in  the 
tissues  of  the  gnat;  and  the  gnat  with  spotted  wings 
and],  boat-shaped  eggs  in  which  I  found  them  be- 
longed (as  I  subsequently  ascertained)  to  the  genus 
Anopheles.  Of  course  it  was  impossible  absolutely 
to  prove  at  the  time,  on  the  strength  of  these  two 
observations  alone,  that  the  cells  found  by  me  in 
the  gnats  were  indeed  derived  from  the  hamamce- 
bidcs  sucked  up  by  the  insects  in  the  blood  of  the 
patients  on  whom  they  had  fed ;  —  this  proof  was 
obtained  by  subsequent  investigations  of  mine; 
but .  .  .  the  clue  was  obtained :  it  was  necessary  only 
to  follow  it  up  —  an  easy  matter." 


380     THE  HISTORY  OF  MEDICINE 

The  zygote,  which  is  the  ovum  of  the  female  game- 
tocyte  fecundated  by  the  motile  filament  of  the  male 
gametocyte,  gives  rise  to  spores  or  blasts,  which  are 
found  distributed  in  various  parts  of  the  insect. 
"  Beyond  this  it  was  difficult  to  go,  but  at  last,  after 
examining  the  head  and  thorax  of  one  insect,  I 
found  a  large  gland  consisting  of  a  central  duct  sur- 
rounded by  large  grape-like  cells.  My  astonishment 
was  great  when  I  found  that  many  of  these  cells 
were  closely  packed  with  the  blasts,  which  are  not 
in  the  least  like  any  normal  structure  found  in  the 
mosquito.  Now  I  did  not,  at  this  time,  know  what 
this  gland  is.  It  was  speedily  found,  however,  to  be  a 
large  racemose  gland  consisting  of  six  lobes,  three 
lying  on  each  side  of  the  insect's  neck.  The  ducts  of 
the  lobes  finally  unite  in  the  common  channel  which 
runs  along  the  under  surface  of  the  head  and  enters 
the  middle  stylet,  or  lancet,  of  the  insect's  proboscis. 
It  was  impossible  to  avoid  the  obvious  conclusion. 
Observation  after  observation  showed  that  the 
blasts  collect  within  the  cells  of  this  gland.  It  is  the 
salivary  or  poison  gland  of  the  insect,  similar  to  the 
salivary  gland  found  in  many  insects,  the  function  of 
which  in  the  gnat  had  already  been  discovered  — 
although  I  was  not  aware  of  the  fact.  That  function 
is  to  secrete  the  fluid  which  is  injected  by  the  insect  when 
it  punctures  the  skin,  fluid  which  causes  the  well- 
known  irritation  of  the  puncture,  and  which  is 


PREVENTIVE  MEDICINE          381 

probably  meant  either  to  prevent  the  contraction  of 
the  torn  capillaries  or  the  coagulation  of  the  ingested 
blood.  .  .  .  The  blasts  must  evidently  pass  down  the 
ducts  of  the  salivary  gland  into  the  wound  made  by 
the  proboscis  of  the  insect,  and  thus  cause  infection 
in  afresh  vertebrate  host" 

Ross's  investigations  were  carried  on  from  1895  to 
1899.  In  1897  Dr.  W.  G.  MacCallum  discovered  the 
function  of  the  motile  filaments  already  referred  to, 
and  in  1898-99  Bignami  and  others  demonstrated 
that  all  mosquitoes  acting  as  hosts  of  malarial  para- 
sites belong  to  the  genus  Anopheles.  In  1900  Dr. 
Sambon,  accompanied  by  friends  and  servants,  suc- 
ceeded in  living  in  a  malarial  district  near  Rome 
(Ostia)  without  contracting  fever  —  and  that  from 
the  beginning  of  July  till  October  I9th  —  exercis- 
ing the  sole  precaution  of  remaining  within  a  well- 
screened  hut  from  sunset  to  sunrise.  It  was  also 
shown  that  mosquitoes  that  had  bitten  malarial 
patients  in  Italy  could,  when  carried  to  England, 
transmit  the  infection  to  people  who  had  never  been 
in  a  so-called  malarial  district.  Mr.  Manson,  the 
son  of  Dr.  Manson,  submitted  to  the  experiment 
necessary  to  establish  this  fact. 

Methods  of  sanitation,  developed  largely  by  Ross, 
were  soon  extensively  employed  in  the  control  of 
malaria.  These  included  the  use  of  nets  and  wire 
screens,  the  protection  of  tanks  and  other  water 


382     THE  HISTORY  OF  MEDICINE 

receptacles,  the  clearing  away  from  the  neighbor- 
hood of  human  habitations  of  empty  tins,  broken 
bottles,  gourds,  buckets,  and  bits  of  pottery  in  which 
mosquitoes  might  lay  their  eggs,  the  drainage  of 
swamps,  the  filling-in  of  pools  and  puddles,  the 
extirpation  of  undergrowth,  the  oiling  of  stagnant 
waters,  the  killing  of  mosquitoes  by  fumigations, 
and  the  destruction  of  the  larvae  by  means  of  fish 
and  other  natural  enemies.  At  the  same  time  the 
systematic  use  of  quinine  as  a  preventive  was 
greatly  extended  in  the  tropics  through  the  influence 
of  Koch.  Ross  visited  the  west  coast  of  Africa  in 
1899,  and  before  the  close  of  1901  encouraging  re- 
sults of  sanitary  measures  suggested  by  the  discov- 
ery of  the  part  played  by  Anopheles  in  malarial 
infection  were  reported  from  Sierra  Leone,  Lagos, 
Hong-Kong,  certain  points  in  the  Malay  Peninsula, 
as  well  as  from  Italy,  India,  North  Africa,  and  the 
American  Tropics.  In  1902  Ross  received  the  Nobel 
Prize  for  his  efforts  to  control  malaria,  the  scourge  of 
the  tropics,  and  of  all  diseases  whatsoever  probably 
the  most  detrimental  to  the  health  and  efficiency  of 
man.  At  Ismailia,  on  the  Suez  Canal,  where  Ross 
was  in  charge  of  sanitation,  the  number  of  cases  of 
malaria  was  reduced  from  1551  in  1902  to  37  (all 
cases  of  relapse)  in  1905. 

It  was  by  the  ingenuity  and  resolution  of  Major 
Walter  Reed,  an  American  army  surgeon,  that  an- 


PREVENTIVE  MEDICINE          383 

other  great  triumph  over  tropical  disease  was  made 
possible.  Born  in  Virginia  in  1851,  he  succeeded  by 
severe  application  to  study  in  securing  the  doctor's 
degree  at  the  University  of  Virginia  before  he  had 
completed  his  nineteenth  year.  He  continued  his 
medical  studies  in  the  Bellevue  Hospital  Medical 
College,  New  York,  had  considerable  hospital  ex- 
perience in  that  city  and  in  Brooklyn,  became  dis- 
trict physician  in  one  of  the  poorest  parts  of  the 
metropolis,  and  was  appointed  one  of  five  inspectors 
on  the  Brooklyn  Board  of  Health.  He  soon  gave  up 
the  idea  of  general  practice,  and,  having  passed  the 
examination  of  the  Medical  Corps  of  the  United 
States  Army,  he  married,  and  at  the  age  of  twenty- 
four  entered  upon  his  garrison  duties  in  the  West. 
He  had  an  extended  experience  of  frontier  life  — 
Arizona,  1876-80,  Nebraska,  1882-87,  and  Dakota, 
1891-93.  For  a  short  time  in  1881  he  was  stationed 
at  Fort  McHenry,  Baltimore,  and  was  able  to  pursue 
at  the  Johns  Hopkins  University  the  study  of  phys- 
iology, but  a  greater  opportunity,  which  he  seized 
with  avidity,  came  in  1890-91,  when  he  served  as 
examiner  of  recruits  at  Baltimore.  He  now  devoted 
himself  to  pathology  and  bacteriology,  and  was  in 
close  relation  with  Welch,  Councilman,  Abbott, 
Thayer,  Nuttall,  and  other  leaders  in  medical  sci- 
ence, at  the  Johns  Hopkins  Hospital.  He  undertook 
an  investigation  into  the  so-called  lymph  nodules  of 


384     THE  HISTORY  OF  MEDICINE 

the  liver  in  typhoid  fever,  and  gave  further  evi- 
dence of  an  aptitude  for  research. 

After  his  two  years  of  service  in  Dakota,  Reed 
was  appointed  curator  of  the  Army  Medical  Mu- 
seum at  Washington  and  professor  of  bacteriology 
in  the  Army  Medical  School.  He  was  deeply  inter- 
ested in  the  discovery  of  the  Klebs-Loffler  bacillus, 
and  was  the  champion  of  the  antitoxin  treatment 
of  diphtheria.  He  made  numerous  contributions  to 
professional  periodicals,  and  prepared  reports  on 
malarial  fevers  at  Washington  Barracks  and  Fort 
Myer,  and  on  serum  diagnosis  in  typhoid  fever.  In 
1897  Reed  and  Dr.  James  Carroll  were  appointed  by 
Surgeon-General  Sternberg  to  investigate  the  claim 
of  Professor  Sanarelli  of  Bologna  that  Bacillus  icter- 
oides,  found  by  the  Italian  scientist  in  the  blood  of 
yellow-fever  patients  in  Brazil,  was  the  cause  of 
yellow  fever.  It  was  especially  desirable  that  the 
organism  observed  by  Sanarelli  should  be  compared 
with  Bacillus  X,  which  had  been  observed  ten  years 
previously,  by  Sternberg  himself,  in  yellow-fever 
patients.  In  a  preliminary  report  in  1899  Carroll 
and  Reed  stated  that  Bacillus  icteroides  (ultimately 
shown  to  be  identical  with  Bacillus  X]  is  really  a 
variety  of  the  hog-cholera  bacillus,  with  which  Reed 
had  become  familiar  while  working  with  Welch  and 
Clement  at  the  Johns  Hopkins  Hospital.  After  the 
beginning  of  the  Spanish- American  War  of  1898, 


PREVENTIVE  MEDICINE          385 

Reed  was  made  chairman  of  a  committee  to  inves- 
tigate the  origin  and  spread  of  typhoid  fever  in  the 
United  States  military  camps,  but  his  great  opening 
came,  when,  in  1900,  yellow  fever  having  broken  out 
among  the  American  troops  in  Cuba,  he  was  made 
chairman  of  an  Army  Board,  composed  of  Carroll, 
Lazear,  Agramonte,  and  himself,  appointed  to  inves- 
tigate the  cause  of  the  disease. 

How  little  was  known,  at  the  time  of  the  Spanish- 
American  War,  concerning  the  cause  of  yellow  fever 
and  its  mode  of  transmission  is  shown  by  a  report  of 
the  officers  of  the  United  States  Marine  Hospital 
Service,  which  declared  that  it  was  spread  by  the 
infection  of  places  and  articles  of  bedding,  clothing, 
and  furniture.  "More  recently,"  this  report  of 
1898  continues,  "the  idea  has  been  advanced  that 
probably  the  germ  of  yellow  fever  enters  the  general 
circulation  through  the  respiratory  organs  in  some 
obscure  manner,  and  incubating  in  the  blood  di- 
rectly poisons  this  life-giving  stream.  However  this 
may  be,  the  present  opinion  is  that  one  has  not  to 
contend  with  an  organism  or  germ  which  may  be 
taken  into  the  body  with  food  or  drink,  but  with  an 
almost  inexplicable  poison  so  insidious  in  its  ap- 
proach and  entrance  that  no  trace  is  left  behind." 
The  American  army  in  Cuba  almost  succumbed  to 
its  unseen  enemies.  After  two  months'  campaigning 
it  "was  utterly  used  up  and  of  no  value  whatever  as 


386     THE  HISTORY  OF  MEDICINE 

a  fighting  machine,"  at  least  four  fifths  of  the  troops 
being  incapacitated  by  tropical  diseases  and  ty- 
phoid. When  Gorgas  took  control  of  the  sanitation 
of  Havana  he  was  influenced  by  the  rather  vague 
assumption  that  yellow  fever  was  a  filth  disease. 
Though  he  was  thrown  into  daily  contact  with  Dr. 
Carlos  Finlay,  Gorgas  took  very  lightly  the  mos- 
quito hypothesis  which  the  Havana  doctor  had  been 
maintaining  stoutly  since  1881.  By  the  middle  of 
1900  Gorgas  had  made  Havana,  in  his  judgment, 
the  cleanest  city  in  the  world,  but  there  were  more 
cases  of  yellow  fever  than  for  several  years  previ- 
ously, and  the  inhabitants  twitted  him  with  the 
fact  that  the  disease  was  particularly  prevalent  in 
the  cleanest  sections  of  the  Cuban  capital. 

Reed,  who  arrived  at  this  juncture  —  June,  1900 
—  soon  found  his  way,  with  the  able  support  of  Car- 
roll, Lazear,  and  Agramonte,  through  the  welter  of 
misconceptions  concerning  the  etiology  and  trans- 
mission of  yellow  fever.  Some  time  was  spent  by 
the  Board  in  giving  the  coup  de  grdce  to  Sanarelli's 
hypothesis.  Agramonte  had  previously  —  at  San- 
tiago —  found  Bacillus  icteroides  in  thirty-three 
per  cent  of  the  yellow-fever  patients  examined  by 
him.  Now,  however,  eighteen  cultures  from  as  many 
yellow-fever  patients  failed  to  show  the  presence  of 
the  hog-cholera  bacillus.  At  the  end  of  July  Reed 
went  to  the  Pinar  del  Rio  Barracks,  where  a  number 


PREVENTIVE  MEDICINE          387 

of  cases  of  yellow  fever  had  occurred,  and  there  he 
made  two  very  important  observations.  He  noted 
in  the  first  place  that  several  non-immunes  had 
come  into  intimate  contact  with  clothing  and  bed- 
ding contaminated  by  yellow-fever  patients  with- 
out any  apparent  deleterious  effects.  He  noted  in 
the  second  place  that  a  prisoner  confined  with  eight 
others  in  a  cell  of  the  guardhouse  had  contracted  the 
disease,  while  his  companions  had  escaped  infection, 
and  that  it  had  been  surmised  at  the  time  that  the 
victim  had  been  bitten  by  an  insect,  perhaps  by  a 
mosquito.  Very  soon  after  his  arrival  in  Cuba  Reed 
had  taken  account  of  Finlay's  hypothesis,  as  well  as 
of  the  attempts  to  put  it  to  experimental  proof,  and 
had  obtained  from  Finlay  eggs  of  the  Stegomyia,  the 
supposed  carrier  of  the  pathogenic  organism.  More- 
over, Reed  had  been  impressed  by  the  work  of  Ross, 
Bignami,  and  others  concerning  the  dissemination 
of  malaria.  He  declared  it  to  be  "of  the  highest 
importance  that  the  agency  of  an  intermediate  host, 
such  as  the  mosquito,  should  either  be  proven  or 
disproven." 

Ross's  belief  in  an  intermediate  host  had  been 
influenced  by  the  report  of  Dr.  H.  R.  Carter's  ob- 
servations in  Mississippi  (1898)  concerning  the  time 
that  elapsed  between  the  arrival  of  cases  of  yellow 
fever  in  isolated  farmhouses  and  the  occurrence  of 
secondary  infections.  Finlay's  attempts  to  produce 


388     THE  HISTORY  OF  MEDICINE 

yellow  fever  by  the  bite  of  Stegomyia  had  failed 
because  he  did  not  know  that  the  insect  does  not 
become  infectious  till  about  twelve  days  or  more 
after  feeding  on  a  yellow-fever  patient,  and  that 
the  blood  of  the  patient  does  not  infect  the  insect 
except  in  the  first  three  days  of  sickness.  The  first 
experiments  of  Lazear  with  supposedly  infected 
mosquitoes  failed  for  similar  reasons,  but  on  August 
27th,  Dr.  Carroll  allowed  himself  to  be  bitten  by 
mosquitoes  that  had  fed  on  yellow-fever  patients, 
and  one  of  the  insects  was  able  to  produce  the 
desired  result.  After  some  slight  premonitory  symp- 
toms he  developed  a  severe  case  of  yellow  fever 
August  3ist.  On  September  I3th  Lazear,  while 
working  among  yellow-fever  patients  at  Las  Animas 
Hospital,  Havana,  observed  a  mosquito  biting  his 
hand.  He  allowed  it  to  take  its  fill.  He  was  attacked 
by  yellow  fever  September  i8th,  and  died  of  the 
disease  a  week  later.  On  the  basis  of  these  and  other 
cases  Reed  stated  in  the  following  month  —  "The 
Etiology  of  Yellow  Fever:  A  Preliminary  Note"  — 
that  the  mosquito  acts  as  the  intermediate  host  for 
the  parasite  of  yellow  fever.  The  task  remained  by 
a  series  of  well-controlled  experiments  to  support 
this  statement  and  to  test  the  claims  of  other  pos- 
sible means  of  infection  besides  the  bite  of  the  mos- 
quito. Accordingly  a  quarantined  camp,  named  in 
honor  of  Dr.  Lazear,  was  established  about  a  mile 
from  Quemados,  Cuba. 


PREVENTIVE  MEDICINE         389 

"It  was  now  proposed,"  writes  Reed,  "to  attempt 
the  infection  of  non-immune  individuals  in  three 
different  ways,  namely,  first,  by  the  bites  of  mos- 
quitoes which  had  previously  bitten  cases  of  yellow 
fever;  second,  by  the  injection  of  blood  taken  during 
the  early  stages  from  the  general  circulation  of 
those  suffering  from  the  disease;  and,  third,  by 
exposure  to  the  most  intimate  contact  with  fomites. 
For  this  purpose,  in  addition  to  the  seven  tents  pro- 
vided for  the  quartering  of  the  detachment,  two 
frame  buildings  each  14  x  20  feet  in  size  were  con- 
structed. These  buildings,  having  a  capacity  of 
2800  feet,  were  exactly  similar,  except  that  one  of 
them,  known  as  the  'Infected  Mosquito  Buidling,1 
was  divided  near  the  middle  by  a  permanent  wire 
screen  partition  and  had  good  ventilation ;  while  the 
other,  designated  as  the  'Infected  Clothing  Build- 
ing,' was  purposely  so  constructed  as  to  exclude 
anything  like  efficient  ventilation.  These  houses 
were  placed  on  the  opposite  sides  of  a  small  valley, 
about  eighty  yards  apart,  and  each  seventy-five 
yards  distant  from  the  camp  proper.  Both  houses 
were  provided  with  wire  screen  windows  and  double 
wire  screen  doors,  so  that  mosquitoes  could  be  kept 
within  or  without  the  buildings  as  the  experiment- 
ers might  desire." 

On  December  5th  Private  Kissinger,  who  (with 
Moran)  had  volunteered  without  pecuniary  reward, 


390     THE  HISTORY  OF  MEDICINE 

"solely  in  the  interest  of  humanity  and  the  cause  of 
science,"  to  submit  to  the  experiment,  was  bitten  by 
infected  mosquitoes,  and  in  about  three  and  a  half 
days  suffered  an  unmistakable  attack  of  yellow  fever. 
During  the  week  following  the  onset  of  his  illness 
four  other  cases  of  the  disease  were  produced  by  the 
same  means  in  the  Infected  Mosquito  Building. 
On  December  2ist  and  22d  Moran  was  bitten,  and 
on  Christmas  morning  he  had  a  sharp  attack  of  the 
fever;  but  two  other  volunteers,  who  slept  for  fifteen 
nights  on  the  other  side  of  the  wire  screen  partition, 
by  which  the  building  was  divided,  remained  in  good 
health  because  they  were  protected  from  the  mos- 
quitoes. A  building  is  infected  only  in  as  much  as  it 
harbors  infected  mosquitoes.  In  the  Infected  Cloth- 
ing Building  Dr.  Cooke  and  Privates  Folk  and 
Jernigan  slept  every  night  from  November  3Oth  till 
December  iQth  in  close  contact  with  blankets, 
sheets,  pillow-slips  and  pyjamas  polluted  beyond 
description  by  yellow-fever  patients  in  Las  Animas 
Hospital  and  other  institutions.  The  three  remained 
in  perfect  health  in  spite  of  passing  twenty  nights 
in  hot,  ill-ventilated,  and  noisome  quarters.  In  a 
later  experiment  —  January  4,  1901  —  Jernigan  was 
inoculated  with  blood  drawn  from  a  yellow-fever 
patient  in  the  early  stage  of  the  disease.  He  de- 
veloped yellow  fever  in  about  four  days.  Blood 
taken  from  him  within  the  first  three  days  of  his 


PREVENTIVE  MEDICINE         391 

illness  and  injected  into  a  non-immune  proved  cap- 
able of  transmitting  the  disease,  a  fact  which  was 
taken  to  indicate  that  the  casual  agent  is  a  living 
organism  and  not  merely  a  chemical  toxin.  It  was 
further  proved  by  experiment  that  the  blood  of  a 
yellow-fever  patient  remains  infectious  after  passing 
through  a  fine  filter,  but  that  it  loses  its  virulence 
after  being  heated  to  55°  C. 

The  general  conclusions  announced  by  the  Army 
Board  were :  That  yellow  fever  is  conveyed  from  the 
sick  to  the  well  solely  by  the  bite  of  the  female 
Stegomyia  mosquito;  that  the  insect  can  become  in- 
fected only  after  sucking  the  blood  of  a  patient 
within  the  first  three  days  of  the  sickness;  that  the 
period  of  extrinsic  incubation  is  from  twelve  to 
twenty  days ;  that  the  period  of  intrinsic  incubation 
is  from  three  to  six  days;  that  yellow  fever  may  be 
produced  artificially  by  injecting  a  non-immune 
with  the  blood  of  a  patient  in  the  early  stage  of  the 
disease;  and  that  the  causal  agent  of  yellow  fever 
is  a  sub-microscopic  parasite.  "These  discoveries," 
writes  Gorgas,  "have  been  of  enormous  benefit  to 
mankind,  and  upon  them  has  been  based  the  sani- 
tary work  against  yellow  fever  which  has  been  so 
successful." 

To  the  splendid  efforts  of  Major  (later  Surgeon- 
General)  Gorgas,  who  at  the  time  of  the  Army 
Board's  report  —  February,  1901  —  was  chief  sani- 


392     THE  HISTORY  OF  MEDICINE 

tary  officer  of  Havana,  the  practical  success  of  con- 
trolling yellow  fever  was  due.  All  cases  of  the  disease 
occurring  in  the  city  were  required  to  be  reported 
immediately  to  the  Health  Department.  The  pa- 
tients were  carefully  screened  from  mosquitoes  in 
order  that  they  might  not  become  the  source  of 
further  infection.  A  war  was  carried  on  against  the 
insects  by  the  use  of  fumigations  of  sulphur  and  of 
pyrethrum  powder,  by  the  destruction  of  larvae, 
and  by  the  protection  of  barrels,  cisterns,  etc.,  and 
by  the  removal  of  tin  cans  and  other  breeding-places. 
Any  ship  with  yellow  fever  on  board  was  fumigated 
in  order  to  kill  infected  mosquitoes,  and  the  non- 
immune  passengers  or  members  of  the  crew  were 
detained  at  a  quarantine  station  for  a  period  of  six 
days.  There  had  been  three  hundred  and  ten  deaths 
from  yellow  fever  in  Havana  in  1900;  there  were 
only  eighteen  in  1901.  Of  these  eighteen  cases, 
seven  occurred  in  the  month  of  January,  five  in 
February,  one  in  March,  one  in  July,  two  in  August, 
and  two  in  September.  For  the  first  time  since  the 
capture  of  Havana  by  the  British  during  the  Seven 
Years'  War,  the  city  became  free  from  yellow  fever. 
"For  two  hundred  years  before  this  time  [1762]," 
writes  Gorgas,  "Havana  had  been  subject  to  epi- 
demics of  yellow  fever,  but  from  1762  up  to  the 
year  1901,  there  was  probably  not  a  single  day  when 
Havana  did  not  have  a  case  of  this  disease  within  its 


PREVENTIVE  MEDICINE         393 

bounds."  Gorgas  attacked  the  Anopheles  mosquito, 
as  well  as  the  Stegomyia,  and  the  number  of  deaths 
from  malaria  in  Havana  was  reduced  from  three 
hundred  and  twenty- five  in  1900,  to  one  hundred 
and  fifty-one  in  1901,  to  seventy-seven  in  1902,  and 
to  four  in  1912. 

Early  in  1902  Gorgas  called  the  attention  of 
Surgeon-General  Sternberg  to  the  value  of  applying 
the  principles  established  by  the  Reed  Board  to  the 
sanitation  of  the  Isthmus  of  Panama  in  case  the 
United  States  should  take  over  the  construction  of 
the  Canal.  He  was  soon  relieved  of  duty  at  Havana, 
and  ordered  to  the  United  States  in  order  that  he 
might  be  in  touch  with  preparations  for  work  on 
the  Isthmus.  In  the  spring  of  1904  he,  as  sanitary 
adviser  accompanied  the  Commission  (Isthmian 
Canal)  on  a  visit  of  inspection  to  Panama.  His 
organization  began  in  June.  Finding  "that  the 
French  had  lost  yearly  by  death  from  yellow  fever 
about  one  third  of  their  white  force,"  he  made  an 
onslaught  on  the  mosquitoes,  principally  by  the  use 
of  fumigations  in  the  city  of  Panama.  Success  was 
not  immediate.  There  was  a  great  deal  of  yellow 
fever  within  the  ensuing  twelve  months,  but  in  the 
autumn  of  1905  the  number  of  cases  rapidly  de- 
clined. After  November  the  disease  ceased  to  exist 
in  the  city  of  Panama.  One  case  occurred  at  Colon 
in  the  spring  of  1906,  but  since  then  not  one  case  of 
yellow  fever  has  originated  on  the  Isthmus. 


394     THE  HISTORY  OF  MEDICINE 

"Of  the  six  important  tropical  diseases,"  says 
Osier,  "plague,  which  reached  the  Isthmus  one 
year,  was  quickly  held  in  check.  Yellow  fever,  the 
most  dreaded  of  them  all,  never  recurred.  Beri-beri, 
which  in  1906  caused  sixty-eight  deaths,  has  gradu- 
ally disappeared.  The  hookworm  disease,  ankylo- 
stomiasis,  has  steadily  decreased.  From  the  very 
outset,  malaria  has  been  taken  as  the  measure  of 
sanitary  efficiency.  Throughout  the  French  occu- 
pation it  was  the  chief  enemy  to  be  considered,  not 
only  because  of  its  fatality,  but  on  account  of  the 
prolonged  incapacity  following  infection.  In  1906, 
out  of  every  1000  employees  there  were  admitted  to 
the  hospital  from  malaria  821 ;  in  1907,  424;  in  1908, 
282;  in  1912,  no;  in  1915,  51;  in  1917,  14.  The 
mortality  from  the  disease  has  fallen  from  233  in 
1906  to  154  in  1907,  to  73  in  1908  and  to  7  in  1914. 
The  death  rate  for  malarial  fever  per  1000  popula- 
tion sank  from  8.49  in  1906  to  o.n  in  1918.  Dysen- 
tery, next  to  malaria  the  most  serious  of  the  tropical 
diseases  in  the  Zone,  caused  69  deaths  in  1906;  48  in 
1907 ;  in  1908,  with  nearly  44,000  only  16  deaths,  and 
in  1914,  4." 

REFERENCES 

Gorgas,  W.  C.:  Sanitation  in  Panama.  1915.  298  pp. 
Kelly,  H.  A.:  Walter  Reed  and  Yellow  Fever.   1906.  293  pp. 
Lankester,  E.  Ray:  The  Kingdom  of  Man  (chapter  in,  "Sleeping 
Sickness").    1907.    191  pp. 


PREVENTIVE  MEDICINE          395 

Masters,  Walter  E.:    Essentials  of  Tropical  Medicine.    1920. 

702  pp. 
Osier,  Sir  William:    The  Evolution  of  Modern  Medicine.    1921. 

243  PP- 
*  Rosenau,  Milton  J.:  Preventive  Medicine  and  Hygiene.    1914. 

1074  pp. 

Ross,  Sir  Ronald:  Mosquito  Brigades  and  How  to  Organize  Them. 
1901.  98  pp. 


CHAPTER  XX 
MEDICAL  SCIENCE  AND  MODERN  WARFARE 

THE  achievements  of  medical  science  in  the  emer- 
gency created  by  the  outbreak  of  war  in  1914  were 
owing  in  no  inconsiderable  degree  to  officers  imbued 
with  the  spirit  of  research  and  with  the  enterprise 
that  had  checked  the  ravages  of  yellow  fever  and 
malaria,  discovered  the  cause  and  the  mode  of 
transmission  of  Malta  fever  and  trypanosomiasis, 
developed  a  treatment  for  amoebic  dysentery, 
adopted  measures  for  the  cure  of  beri-beri,  and 
dealt  successfully  with  hundreds  of  thousands  of 
cases  of  hookworm  disease. 

Preventive  measures  against  typhoid,  the  appli- 
cation of  which  to  millions  of  men  was  one  of  the 
important  successes  of  the  World  War,  were  made 
possible  by  the  work  of  Sir  Almroth  Wright  and 
others.  The  Bacillus  typhosus  had  been  discovered 
by  Eberth  in  1880.  In  1896  Pfeiffer  and  Kolle  suc- 
ceeded in  inoculating  two  volunteers  with  the 
disease.  In  this  same  year  Wright  devised  his  pre- 
ventive inoculation  —  an  emulsion  of  dead  typhoid 
bacteria.  With  this  he  inoculated  British  troops  in 
India  to  about  the  number  of  four  thousand  in  1898- 
1900.  During  the  Boer  War  Wright,  in  cooperation 


MEDICAL  SCIENCE  AND  WARFARE  397 

with  Sir  William  Leishman,  extended  the  prophylac- 
tic treatment  to  100,000  troops  in  South  Africa. 
It  was  adopted  by  the  medical  officers  of  the  French 
and  German  colonial  troops.  The  prevention  of 
typhoid  among  the  Japanese  soldiers  was  one  of  the 
outstanding  features  of  the  Russo-Japanese  War  of 
1904.  Of  12,801  men  of  the  United  States  army, 
who  during  the  Mexican  border  troubles  of  1912  had 
received  preventive  treatment  under  the  direction 
of  Major  Russell,  only  two  developed  typhoid.  This 
result  is  all  the  more  striking  when  we  recall  that 
at  the  time  of  the  Spanish-American  War  there  had 
been  among  107,973  men  in  the  United  States 
encampments  20,738  cases  of  typhoid  fever  and 
1580  deaths.  During  the  World  War  preventive 
measures,  including  the  chlorination  of  waters  and 
the  control  of  carriers,  were  made  more  and  more 
effective.  The  technique  of  prophylactic  inocula- 
tion was  developed  among  the  British  by  officers 
working  under  the  direction  of  Leishman.  From  the 
beginning  of  1916  the  triple  vaccine,  for  the  pre- 
vention of  the  paratyphoids  —  the  bacteriology  of 
which  had  been  set  forth  by  Buxton  in  1902  —  as 
well  as  of  typhoid  proper,  came  into  use,  and  was 
followed  by  other  polyvaccines.  Among  the  mil- 
lions of  United  States  troops,  in  the  two  years  sub- 
sequent to  the  declaration  of  war  in  April,  1917* 
there  were  only  227  deaths  from  typhoid  fever. 


398     THE  HISTORY  OF  MEDICINE 

The  labors,  toward  the  close  of  the  nineteenth  cen- 
tury, of  the  Prussian  army  surgeon  Emil  von  Behring 
and  others  had  prepared  the  way  for  the  successful 
employment  of  serums  in  the  World  War.  The  Bacil- 
lus tetani  had  been  discovered  by  Nicolaier  in  1884. 
Five  years  later  Kitasato  had  succeeded  in  growing 
the  organism  in  pure  culture.  In  1890  von  Behring 
in  collaboration  with  Kitasato  published  an  article 
concerning  the  production  of  diphtheria  immunity 
and  tetanus  immunity  in  animals.  His  serum  ther- 
apy (as  explained  in  Die  Blutserumtherapie,  1892) 
is  founded  on  the  principle  that  the  serum  of  animals 
rendered  immune  to  a  disease  acts,  if  introduced 
into  a  living  organism,  as  an  antidote  to  the  virus 
of  the  bacteria  concerned.  In  the  first  part  of  the 
World  War  there  were  a  great  many  losses  through 
tetanus  —  so  many,  in  fact,  among  the  allied 
troops  in  the  weeks  following  the  first  battle  of  the 
Marne  as  to  give  rise  to  the  most  serious  apprehen- 
sions. In  the  month  of  October,  1914,  the  ratio  of 
cases  among  the  wounded  was  32:  1000.  This  was 
quickly  reduced  to  2 : 1000  by  the  use  of  anti-tetanus 
serum.  During  the  war  the  serum  treatment  was 
used  also  to  control  cerebrospinal  meningitis.  The 
pathogenic  organism  had  been  isolated  by  Weichsel- 
baum  in  1887.  Dr.  Simon  Flexner  had  undertaken 
the  investigation  of  the  disease  in  1905  and  after  a 
series  of  experiments  bad  produced  a  prophylactic 


MEDICAL  SCIENCE  AND  WARFARE   399 

serum.  In  1914-15  a  severe  epidemic  broke  out 
among  the  Canadian  troops  and  (according  to 
Osier)  the  infection  was  carried  by  them  to  England. 
It  was  particularly  rife  in  the  camp  on  Salisbury 
Plain.  In  1915  it  was  discovered  that  a  better  serum 
could  be  prepared  by  injecting  into  animals  dif- 
ferent strains  of  the  menigococcus,  the  differentia- 
tion of  which  is  still  under  investigation.  It  was 
also  found  desirable  to  isolate  soldiers  suspected  of 
being  carriers,  as  the  infection  is  readily  conveyed 
from  person  to  person  by  coughing  and  sneezing. 

Influenza,  another  disease  disseminated  through 
discharges  from  the  mouth  and  nose,  baffled  the 
resources  of  medical  science,  and  became  very 
deadly  in  the  armies,  as  well  as  in  the  civil  pop- 
ulations throughout  the  world.  For  example,  it 
began  to  attract  special  attention  among  the  British 
troops  on  the  northern  part  of  the  western  front 
about  April,  1918,  that  is,  a  few  weeks  after  the 
beginning  of  the  final  campaign.  It  was  soon  known 
to  be  pandemic  and  extremely  infectious.  The 
earlier  cases  were  quite  mild,  but  the  disease  became, 
as  it  spread,  more  and  more  virulent.  June  23d  a 
committee  which  had  been  appointed  to  study 
influenza  reported  to  the  Director  General  of  the 
Medical  Services  that  the  contagion  of  this  disease 
appears  to  be  air-borne.  "The  main  principle  to  be 
followed,  therefore,  is  to  spread  troops  as  widely 


400  .  THE  HISTORY  OF  MEDICINE 

as  possible,  avoiding  the  crowding  of  men  in  tents, 
billets,  messrooms,  etc."  Whenever  the  military  situ- 
ation permitted,  the  troops  were  to  sleep  in  the  open 
air  in  individual  blanket-shelters.  Influenza  patients 
were  to  be  kept  separate  from  other  patients.  Of 
course  it  was  frequently  impossible  to  live  up  to 
the  sanitary  suggestions  contained  in  this  British 
report.  This  was  notably  the  case  in  the  transporta- 
tion of  troops.  In  September  the  American  trans- 
port Nestor  left  the  United  States  for  England  with 
2807  soldiers  on  board.  Two  or  three  days  later  she 
was  forced  to  land  660  patients  and  contacts  at 
Sydney,  Cape  Breton.  But,  in  spite  of  this  precau- 
tion, looo  more  men  were  taken  ill  before  the  ship 
reached  Liverpool.  The  military  camps  in  the 
United  States  were  severely  smitten,  and  the  deaths 
from  influenza  and  its  complications  outnumbered 
the  country's  total  losses  in  battle. 

The  stimulating  influence  of  war  on  research  in 
the  various  sciences  is  obvious  to  every  student  of 
history.  The  effect  of  the  World  War  on  the  prog- 
ress of  medical  science  was  early  recognized  and  is 
becoming  every  day  more  manifest.  At  the  begin- 
ning of  1917  Sir  F.  W.  Andrewes  expressed  the 
opinion  "that  in  pathology,  no  less  than  in  the  other 
sciences,  advances  have  been  made,  under  the 
stress  of  national  necessity,  during  the  two  years 
and  a  half  of  war  which  could  hardly  have  been 


MEDICAL  SCIENCE  AND  WARFARE  401 

expected  in  twenty  years  of  ordinary  work;  and 
although  it  has  been  'war  work,'  it  represents  a 
solid  contribution  to  science  which  will  be  valid  for 
the  years  of  peace  to  come."  The  occurrence  of 
dysentery  among  the  troops  in  Gallipoli,  Egypt, 
Mesopotamia,  and  other  regions  led  to  a  renewed 
investigation  of  the  causative  agents  of  both  the 
bacillary  and  amoebic  forms  of  the  disease,  and  to  a 
modification  of  the  use  of  emetine  and  emetine 
bismuth  iodide  in  the  treatment  of  amoebic  dys- 
entery. Ailments  like  trench  foot,  trench  nephritis, 
and  trench  fever,  incident  to  life  at  the  front  under 
new  and  peculiar  conditions,  were  a  challenge  to  the 
medical  science  of  the  twentieth  century  as  syphilis 
had  been  to  the  less  highly  developed  medical  science 
of  the  sixteenth  century.  Trench  fever,  named  toward 
the  end  of  1915,  was  proved  by  investigations  to  be 
transmitted  by  the  louse,  and  this  discovery  sug- 
gested as  a  means  of  control  such  a  crusade  against 
the  insect  carriers  as  had  proved  effective  in  combat- 
ing typhus  in  Serbia  and  elsewhere.  Trench  fever 
is  probably  not  only  a  newly  recognized  disease  but 
an  absolutely  new  disease,  caused  by  a  micro- 
organism which  has  now  for  the  first  time  invaded 
the  tissues  of  man.  Trench  nephritis,  on  the  other 
hand,  had  been  described  during  the  American 
Civil  War.  Soldier's  heart,  closely  studied  by  J.  M. 
Da  Costa  among  the  Federal  troops,  had  been 


402     THE  HISTORY  OF  MEDICINE 

observed  in  the  Crimean  War.  After  the  outbreak 
of  the  World  War  disordered  action  of  the  heart 
(investigated  by  Allbutt  and  others)  as  well  as 
pyrexias  of  uncertain  origin,  became  familiar  to 
every  medical  officer.  Infective  jaundice,  which 
was  no  doubt  rife  among  the  American  soldiers  in 
1861-65,  and  is  now  known  to  be  caused  by  a  para- 
site (Spirochata  icterohcemorrhagice),  was  epidemic 
at  times  during  the  recent  war;  while  toxic  jaundice 
was  of  frequent  occurrence  in  munition  factories. 

Observations  made  during  the  World  War  give 
considerable  promise  of  advance  in  our  knowledge 
of  psychiatry.  Some  of  the  methods  of  testing  the 
mental  fitness  of  the  men  and  of  rating  the  officers 
were  rather  crude  and  illogical,  and  the  statistical 
methods  applied  to  the  data  led  at  times  to  results 
which  the  scientific  mind  will  receive  with  caution. 
Nevertheless,  great  enterprise  was  shown  —  notably 
in  America  —  in  the  task  of  taking  stock  of  the 
mental  equipment  of  millions  of  young  men.  It  has 
been  claimed  as  the  result  of  extensive  investigation 
that  a  very  large  percentage  of  twelve-year-old 
minds  is  found  among  American  men  of  military 
age.  The  records  of  the  discharge  of  soldiers  from 
the  British  armies  as  permanently  unfit  on  account 
of  nervous  or  mental  diseases  have,  similarly,  been 
regarded  as  indicating  that  a  considerable  propor- 
tion of  the  male  population  of  a  highly  civilized 


MEDICAL  SCIENCE  AND  WARFARE  403 

country  possesses  a  neurotic  or  neuropathic  predis- 
position. 

The  British  War  Office  recognized  three  forms  of 
war  neurosis  —  shell  shock,  hysteria,  and  neuras- 
thenia. Needless  to  say,  the  symptoms  described 
under  each  of  these  categories  show  that  the  classifi- 
cation was  not  wholly  satisfactory.  Some  cases 
included  under  shell  shock  were  definitely  known  to 
be  the  result  of  the  percussion  of  explosives,  to  the 
direct  effect  of  which  organic  changes,  like  the  rup- 
ture of  the  tympanic  membrane  and  the  alteration 
of  the  spinal  fluid,  bore  witness.  Other  cases  of  shell 
shock  seemed  more  purely  psychic  in  their  mani- 
festations. Both  types  contributed  to  corroborate 
the  teachings  of  Darwin  and  James  concerning  the 
intimate  relations  between  the  emotions  —  fear,  for 
example  —  and  the  physiological  concomitants  of 
the  emotions.  Does  the  shattering  effect,  on  the 
body,  of  air-vibrations  constitute  the  agitation  we 
call  fear,  or  does  the  recognition  of  danger  provoke 
the  physiological  symptoms?  The  well-attested  fact 
that  a  cold  wind  playing  upon  a  sleeper  may  give 
rise  to  a  dream  of  fear  seems  to  support  the  view 
that  it  is  the  bodily  state  that  gives  substance  and 
character  to  the  emotion. 

Colonel  Mott  holds  that  in  any  case  there  is  a 
vicious  circle,  the  perceptual  feeling  of  fear  stimulat- 
ing the  physiological  svmptoms  and  these  in  turn 


404     THE  HISTORY  OF  MEDICINE 

giving  reinforcement  to  the  psychic  condition.  In 
his  patients  he  found  evidence  of  a  persistence  of  the 
bodily  changes  characteristic  of  a  state  of  fear. 
About  ten  per  cent  of  the  cases  of  severe  neuras- 
thenia showed  some  of  the  symptoms  of  Graves's 
disease,  among  the  exciting  causes  of  which  fright, 
worry,  and  mental  shock  have  long  been  recognized. 
Other  cases  gave  evidence  of  an  unusual  amount  of 
adrenin  in  the  blood,  an  increase  of  which  secretion 
occurs  as  a  result  of  fright,  as  has  been  shown  ex- 
perimentally by  Cannon.  The  view  here  taken  con- 
cerning the  importance  for  the  emotional  life  of  the 
internal  secretions  —  of  the  thyroid  as  well  as  the 
adrenals  —  might  be  supported  by  referring  to 
Addison's  disease,  in  which  the  atrophy  of  the 
adrenals  may  give  rise  to  languor,  anaemia,  and 
cardio-vascular  asthenia.  Fear,  including  the  in- 
creased heart  rate,  is  a  preparation  for  fight  or 
flight;  but,  as  Mott  remarks,  in  trench  warfare, 
which  is  particularly  prolific  of  war  neuroses,  the 
emotions  are  deprived  of  their  natural  functions. 
The  soldier  can  neither  fight  nor  take  refuge  in 
flight;  he  can  only  adopt  the  crouching  attitude  of 
immobility.  The  result  may  be  a  deep-seated 
emotional  derangement. 

"In  the  dreams  of  soldiers,  ideas  of  past  war 
experiences  are  revived  with  great  vividness  in  the 
great  majority  of  cases,  even  in  those  who  are  unable 


MEDICAL  SCIENCE  AND  WARFARE  405 

to  recollect  their  dreams.  For  besides  those  patients 
who  wake  up  in  a  fright  and  cold  sweat,  there  have 
been  numerous  instances  of  soldiers  who  have 
walked  in  their  sleep,  and  many  others  have  talked, 
shouted  out  orders,  and  cried  out  in  alarm  as  if 
again  engaged  in  battle  (not  a  few  of  these  have  been 
mutes).  But  the  strangest  phenomena  of  forgotten 
dreams  of  soldiers  suffering  from  shock  are  observed 
in  those  who  in  their  sleep  act  as  though  they  were 
engaged  in  battle,  and  go  through  the  pantomime  of 
fighting  with  bombs,  with  bayonet,  with  machine 
gun  and  with  rifle,  and  yet  remember  none  of  these 
things  when  they  wake.  Evidently  during  their 
sleep  vivid  imaginings  of  their  previous  experiences 
are  arousing  defensive  and  offensive  reactions  in 
face  of  the  imaginary  enemy."  Neuropathic  patients 
who  show  symptoms,  in  the  early  morning,  of 
nervous  exhaustion  and  irritability  are  not  infre- 
quently the  victims  of  dreams  of  a  highly  emotional 
sort  which  may  be  beyond  the  power  of  recall  of  the 
waking  consciousness. 

In  the  treatment  of  war  hysteria  persuasion,  sug- 
gestion and  psychoanalysis  proved  effective.  It 
was  found  advisable  to  explain  the  symptoms  and 
the  nature  of  the  neurosis  to  a  few  of  the  more  intel- 
ligent patients  and  to  employ  their  powers  of  per- 
suasion to  induce  a  new  mental  attitude  in  the 
others.  Grateful  patients  already  on  the  highroad 


406     THE  HISTORY  OF  MEDICINE 

to  recovery  thus  became  very  helpful  in  bringing 
about  cures.  Any  form  of  treatment  that  inspired 
in  the  patient  the  confidence  that  something  effec- 
tive was  being  done  in  his  behalf  had  a  therapeutic 
value.  Even  where  no  bodily  derangement  was 
suspected  a  thorough  physical  examination  was 
necessary  in  order  to  establish  the  physician  in  the 
confidence  of  the  patient.  The  physician's  personal- 
ity and  the  surroundings  generally  had  a  powerful 
influence  on  the  suggestible  minds  of  the  patients. 
In  addition  to  its  suggestive  value  electricity  enabled 
the  physician  to  prove  to  patients  suffering  from 
hysterical  paralysis  that  their  muscles  had  not  lost 
the  power  of  contraction.  It  also  restored  sensibility 
in  cases  of  hysterical  anaesthesia,  and  thus  renewed 
the  patients'  consciousness  of  the  affected  parts. 
Passive  movements  of  an  apparently  paralyzed 
limb  might  afford  the  kinaesthetic  cue  for  active, 
voluntary  movements.  The  method  of  psychoanaly- 
sis —  breaking  down  dissociations  and  inducing  an 
integration  of  consciousness  by  the  revival  of  re- 
pressed emotional  experiences  —  found  many  cham- 
pions among  those  who  succeeded  in  the  treatment 
of  war  hysteria.  The  revival  of  the  repressed  experi- 
ence —  such  as  remorse  in  connection  with  the 
death  of  a  comrade  —  must  be  emotional  in  char- 
acter in  order  to  bring  about  a  satisfactory  catharsis; 
and  the  revived  experience  should  be  recalled  again 


MEDICAL  SCIENCE  AND  WARFARE  407 

and  again  till  the  memory  loses  its  dramatic  vivid- 
ness. The  fact  that  an  anxiety  neurosis  may  super- 
vene on  the  removal  of  the  hysterical  symptoms 
should  warn  us  that  dissociation  is  after  all  a  means 
of  defense  against  unbearable  mental  strain.  "My 
dearest  wish,"  wrote  a  young  correspondent  towards 
the  close  of  the  war,  "is  to  forget  the  whole  grew- 
some  business."  What  Culpin  calls  "the  ever- 
growing sense  of  horror"  led  at  times  to  prolonged 
amnesias,  the  treatment  of  which  by  the  method  of 
psychoanalysis  had  to  be  undertaken  with  the  ut- 
most caution. 

In  reporting  on  the  surgical  developments  of  the 
World  War  Dr.  W.  S.  Bainbridge  writes:  "In  the 
many  hospitals  and  casualty  clearing  stations 
visited,  the  method  of  treating  war  wounds  varied 
greatly.  There  were  those  who  believed  in  the  use 
of  the  strongest  antiseptics,  as  at  the  Grand  Palais, 
where  phenolization  was  employed,  while  others 
favored  incising  freely  with  drainage  and  practically 
no  antiseptics.  More  and  more  the  two  extremes  are 
being  emphasized;  on  the  one  hand,  the  Carrel 
treatment  with  its  scientific  laboratory  control  and 
systematic  use  of  strong  antiseptic  solutions,  and  on 
the  other,  debridement  and  immediate  closure."  The 
failure  of  the  ordinary  antiseptic  methods  to  meet 
the  conditions  of  warfare  on  the  western  front,  where 
the  heavily  manured  soil  was  charged  with  or- 


408     THE  HISTORY  OF  MEDICINE 

ganisms,  soon  led  to  modifications,  such  as  the  use 
of  drainage  with  antiseptics,  and  the  use  of  hypo- 
chlorites.  The  Carrel  method,  which  attracted  gen- 
eral attention  in  1916,  soon  found  rivals  in  other  es- 
sentially antiseptic  methods.  In  1917-18  the  method 
of  primary  wound  suture,  immediate  or  delayed, 
came  into  special  prominence.  "Under  favorable 
conditions,"  continues  Bainbridge,  "primary  union 
by  immediate  or  delayed  suture  of  war  wounds 
which  have  been  operated  on  and  properly  purified, 
is  now  the  last  word  in  this  branch  of  surgery.  Ex- 
perience in  the  World  War  has  taught  entirely  new 
lessons  to  the  surgeons  who  found  themselves  con- 
fronted with  unprecedented  conditions  both  in 
regard  to  the  masses  and  classes  of  war  wounds 
they  were  expected  to  handle.  Perhaps  the  most 
important  lesson  of  all,  with  the  closest  bearing  on 
wound  treatment  in  general,  consists  in  the  recogni- 
tion of  the  fact  that  antiseptics  are  inefficient  with- 
out the  most  careful  and  thorough  mechanical 
purification  of  the  wound,  including  the  complete 
removal  of  all  dead  or  nonviable  tissue." 

Sir  Henry  Gray  expresses  a  similar  conclusion. 
"Much  discussion,"  he  writes,  "took  place  during 
the  early  periods  of  the  war  as  to  the  best  form  of 
dressing  and  the  most  effective  lotions  to  be  em- 
ployed in  the  treatment  of  wounds.  It  was  hoped 
that  by  the  early  use  of  suitable  disinfectants  much 


MEDICAL  SCIENCE  AND  WARFARE  409 

would  be  done  to  combat  the  onset  of  sepsis.  It  has 
been  found  that  antiseptics  per  se  have  but  little 
influence  in  this  direction,  and  that  the  best  hope  of 
averting  the  danger  of  severe  sepsis  lies  in  early  and 
efficient  operation.  The  use  of  ordinary  disinfectants 
and  impregnated  dressings  is  of  little  or  no  value  in 
most  cases  until  such  operation  has  been  carried 
out."  He  adds  that  eusol  and  similar  solutions  are 
too  evanescent  in  antiseptic  action  when  in  contact 
with  the  tissues  to  make  their  use  worth  while,  and 
Carrel's  method  is  out  of  the  question  in  the  early 
treatment  of  war  wounds.  The  experience  of  the 
twentieth  century  has  confirmed  the  judgment  of 
the  sixteenth  that  all  gunshot  wounds  are  necessarily 
infected,  and  for  Gray  sepsis,  shock  and  haemorrhage 
are  interdependent  phenomena.  The  wounded  must 
be  carefully  guarded  against  all  emotional  and  sen- 
sory stimuli  liable  to  provoke  shock,  and  the  loss  of 
every  additional  ounce  of  blood  is  of  the  utmost 
importance.  "Nothing,"  as  Gray  says,  "has  been 
more  striking  than  the  rapid  spread  of  the  use  of 
blood  transfusion  as  a  therapeutic  measure  for  the 
combating  of  shock-haemorrhage.  During  the  first 
two  years  of  the  war  transfusion  was  performed  only 
by  a  few  specially  experienced  surgeons,  and  was 
regarded  more  as  an  interesting  curiosity  than  as  a 
practical  measure  in  the  treatment  of  shock.  It  is 
only  during  the  last  two  years  that  its  scope  has 


410     THE  HISTORY  OF  MEDICINE 

been  realized,  and  that  ft  has  been  adopted  as  a 
recognized  part  of  the  treatment  of  the  severely 
wounded  man." 

War  surgery  was  greatly  facilitated  by  improved 
methods  of  anaesthesia,  as  well  as  by  radiography 
and  other  means  of  determining  before  operation 
the  nature  of  the  injury  and  the  exact  location  of 
bullets,  shrapnel,  or  other  foreign  bodies.  Local  or 
regional  anaesthesia  was  frequently  employed  even 
in  major  operations.  Nitrous  oxide  and  oxygen  came 
into  very  general  use.  Sometimes  these  inhalations 
were  combined  with  small  quantities  of  ether,  or 
administered  after  preliminary  injections,  nerve 
blocking,  etc.  There  occurred  a  revaluation  of  the 
various  anaesthetics  and  combinations  of  anaesthet- 
ics, and  an  increased  discrimination  in  their  use. 
Moreover,  professional  opinion  was  rendered  so 
unsettled  in  reference  to  the  worth  of  the  various 
methods  of  inducing  surgical  anaesthesia  that  the 
search  for  new  drugs  and  anaesthetic  preparations 
has  been  greatly  stimulated. 

In  the  localization  of  foreign  bodies,  as  well  as  of 
fractures  and  other  injuries,  radiography  was  indis- 
pensable. Unless  the  cases  suffering  from  bullet  or 
shrapnel  wounds  were  screened,  it  was  as  a  rule 
impossible  to  conjecture  the  location  of  a  projectile. 
A  bullet  entering  the  back  above  the  scapula  might 
lodge  in  the  anterior  wall  of  the  abdomen  without 


MEDICAL  SCIENCE  AND  WARFARE  411 

its  passage  through  the  lungs  being  revealed  by  any 
remarkable  symptoms.  Small  fluorescent  screens 
that  could  be  closely  applied  to  the  skin  of  the 
patients  were  used  by  some  radiographers.  Frac- 
tures and  other  injuries  that  could  not  be  detected 
on  the  screen  were  often  revealed  by  an  examination 
of  the  plates.  In  many  cases  stereoscopic  radio- 
graphs proved  invaluable  to  the  operator.  Besides 
radiography,  other  ingenious  devices  were  used  in 
the  localization  of  bullets  and  other  projectiles. 

The  exigencies  of  the  World  War  entailed  a  very 
great  extension  of  orthopaedic  surgery.  Through  the 
activity  of  Sir  Robert  Jones  —  exponent  of  the 
practice  and  principles  of  Hugh  Owen  Thomas  and 
John  Hunter  —  the  British  Orthopaedic  Centers 
with  only  two  hundred  and  fifty  beds  at  the  start 
developed  into  the  Special  Military  Surgical  Hospi- 
tals with  thirty  thousand  beds.  In  these  institutions 
the  general  surgeon,  the  orthopaedic  surgeon,  the 
neurologist,  as  well  as  the  experts  in  hydrotherapy, 
massage,  gymnastics,  vocational  training,  etc., 
cooperated  in  the  repair  of  injuries  and  the  restora- 
tion of  the  functions  of  nerves  and  muscles.  To 
obtain  the  best  results  it  was  essential  to  secure  con- 
tinuity of  treatment.  The  importance  of  the  work 
of  the  advanced  units  in  the  prevention  of  deformi- 
ties was  very  clearly  recognized.  At  the  earliest 
possible  moment  after  the  occurrence  of  a  fracture 


412     THE  HISTORY  OF  MEDICINE 

It  became  the  practice  to  adjust  a  suitable  splint, 
such  as  a  Thomas  leg  splint  or  a  swiveled  Thomas 
arm  splint.  Fractures  of  the  femur  at  the  beginning 
of  the  war  frequently  resulted  in  serious  deformities ; 
later,  Jones  was  able  to  report  a  series  of  five  hun- 
dred cases  of  compound  fracture  of  the  femur  with 
an  average  shortening  of  less  than  half  an  inch. 
Remarkable  successes  were  gained  by  the  patient 
treatment  of  comminuted  septic  fractures.  In  the 
judgment  of  Sir  Robert  Jones  "the  weight  of  the 
body  should  not  be  allowed  on  the  unsupported 
femur  for  at  least  six  months  after  the  recumbent 
treatment  of  the  fracture."  A  badly  sprained  ankle, 
however,  should  make  a  complete  recovery  in  four- 
teen days:  whereas  immobilization  for  weeks  in 
plaster  would  indefinitely  perpetuate  weakness  and 
disability.  The  theory  of  the  Belgian  surgeon  Wil- 
lems  that  joint  lesions  should  be  treated  on  the 
principle  of  immediate  active  mobilization  led  of 
course  to  a  procedure  far  more  drastic  than  any 
employed  in  the  British  Special  Military  Surgical 
Hospitals,  where  an  opposed  principle  in  the  main 
prevailed. 

One  of  the  outstanding  successes  in  restorative 
work  was  the  plastic  surgery  at  Queen's  Hospital, 
Sidcup,  at  Val-de-Grace  (Paris),  at  Boulogne,  at  Le 
Mans,  and  at  the  American  Ambulance  at  Neuilly. 
The  general  surgeons  and  the  dentists  here  entered 


PLASTIC  SURGERY  OF  THE  FACE 

i  and  2:  Condition  on  admission.  3:  Adjustable  intranasal  support  carried  from 
a  metal  cap  splint  cemented  to  the  upper  teeth.  4:  Improvement  obtained  by  oper- 
ation and  insertion  of  nasal  splint.  5  and  6:  Result  of  insertion  of  cartilage  graft 
from  rib.  (At  Queen's  Hospital,  Sidcup,  by  Major  H.  D.  Gillies.) 


MEDICAL  SCIENCE  AND  WARFARE  413 

into  the  closest  cooperation.  As  early  as  1916  De- 
Iag6niere  reported  a  number  of  cases  in  which  de- 
fects of  the  skull  after  trephining  and  defects  in 
bones  that  had  failed  to  unite  after  fracture  had 
been  successfully  treated  by  means  of  osteoperi- 
osteal  grafts  from  the  tibia.  In  the  following  year 
he  applied  his  method  in  the  treatment  of  the 
inferior  maxilla  and  other  parts  of  the  bony  frame- 
work of  the  face.  Indeed,  he  soon  recognized  that 
any  part  of  the  skeletal  system  may  be  repaired  by 
means  of  grafts.  The  restoration  of  the  faces  of 
soldiers  mangled  by  the  instruments  of  modern  war- 
fare is  rightly  regarded  as  one  of  the  finest  achieve- 
ments of  the  art  of  surgery.  In  their  endeavors  to 
enable  the  mutilated  man  to  resume  his  place  among 
his  fellow-men  the  surgeons  were  supported  by  those 
who  used  their  talents  in  the  modeling  of  masks. 

Successes  gained  by  means  of  bone  grafting  —  the 
most  important  development  of  modern  orthopaedic 
surgery  —  by  ligating  the  upper  part  of  the  femoral 
artery  and  other  large  vessels  in  accordance  with 
the  fundamental  principles  of  vascular  surgery,  by 
the  suture  of  nerves  and  the  transplantation  of  ten- 
dons, by  the  treatment  of  burns  with  solutions  of 
paraffin-resin,  by  resection,  by  the  cooperation  of 
the  surgeon  and  the  bacteriologist  as  in  the  treat- 
ment of  gas  gangrene,  etc.,  convince  us  that  there 
were  a  great  many  unnecessary  amputations  in  the 


414     THE  HISTORY  OF  MEDICINE 

early  stages  of  the  war.  Moreover,  Tuffier  found 
that  a  considerable  number  of  those  whose  limbs 
had  been  amputated  in  1914-15  had  to  undergo  a 
further  operation  before  they  could  take  advantage 
of  prosthetic  devices  of  recent  invention.  However, 
the  severity  of  our  criticism  of  the  medical  and  the 
surgical  treatment  of  the  soldiers  in  the  opening 
years  of  the  World  War  may  be  considered  in  some 
sense  a  measure  of  the  progress  that  has  been  made 
in  the  medical  sciences  in  general,  not  only  in  the 
special  fields  here  emphasized  but  in  the  develop- 
ment of  the  treatment  of  venereal  disease,  in  brain 
and  heart  surgery,  and  in  various  other  depart- 
ments of  the  healing  art. 

REFERENCES 

Allbutt,  Sir  Clifford  T.:  "The  Investigation  of  the  Significance 
of  Disorders  and  Diseases  of  the  Heart  in  Soldiers,"  pp. 
90-92,  British  Medicine  in  the  War  (collected  from  British 
Medical  Journal),  1917. 

Bainbridge,  W.  S.:  "Report  on  Medical  and  Surgical  Develop- 
ments of  the  War,"  U.  S.  Naval  Medical  Bulletin,  1919. 

Culpin,  Millais:  Psychoneuroses  of  War  and  Peace.  Cambridge. 
1920. 

Da  Costa,  J.  M.:  "On  Irritable  Heart."  American  Journal  of 
Medical  Sciences,  1871,  pp.  17-52. 

Gillies,  H.  D.:  Plastic  Surgery  of  the  Face.  Oxford,  1920. 

Gray,  Sir  H.  M.  W.:  The  Early  Treatment  of  War  Wounds.  Lon- 
don, 1919. 

Jones,  Sir  Robert  (editor  and  contributor):  Orthopcedic  Surgery 
of  Injuries.  2  vols.  Oxford,  1921. 

Lelean,  Percy:  Sanitation  in  War.  Philadelphia,  1917. 

Mott,  F.  W.:  "War  Neuroses,"  Handbook,  Clinical  and  Sci- 
entific Meeting,  British  Medical  Association,  1919. 


INDEX 


INDEX 


Abano,  Peter  of,  97. 

Abbott,  383. 

Abdollatif,  74. 

Abernethy,  176,  178. 

Abnormalities,  congenital,  18. 

Abscesses,  30,  81,  82,  100,  186. 

Achillini.  104. 

Achondroplasia,  10. 

Aconite,  89. 

Acoustics,  209,  210. 

Acute  disease,  41. 

Adams,  Francis,  44,  69,  186. 

Addison's  disease,  274,  404. 

Adenitis,  100. 

Adrenin,  404. 

.lEgophony,  213,  214. 

/Esculapius,  23,  33. 

Aetius,  68. 

Agatharcides,  79. 

Agenesia,  272. 

Agramonte,  385  et  seq. 

Albucasis,  80,  09. 

Alchemy,  86-88. 

Alcmaeon,  27,  28. 

Alexander  of  Tralles,  68. 

Alexandra  Galiani,  97. 

Allbutt,  Sir  T.  C.,  44,  69,  353,  414. 

Allgemeines     Krankenhaus      (Munich), 

348,  349. 
Al  Mamun,  74- 
"Almansor,"  75. 
Al  Mansur,  72. 
"Al-Teisir,"  8l. 
Ambidexterity,  58. 
Ambulance,  274. 

American  Ambulance  at  Neullly,  413. 
Amnesia,  407. 
Amphioxus,  254. 
Amputations,  15,  57.  61,  103,  Iia,  343, 

348,  351,  413,  414- 
Amulets,  4,  20. 
Anaemia,  7. 
Anaesthesia,  88,  95,  06,  100,   103,  113, 

178,  276  et  seq.,  337,  410. 
Anastomoses,  65. 
"Anathomia,"  97- 
Anatomy,  9,  10,  17,  28,  46  et  seq.,  91,  92, 

94  et  seq.,  122,  132,  160  et  seq.,  181  et 

seq.,  191  et  seq.,  208,  243  et  seq.,  260, 

263,  309. 

Ancon  sheep,  304. 
Ancylostoma  duodenale,  7,  266. 
Andrewes,  Sir  F.  W.,  400. 
Andry,  Nicolas,  316. 
Aneurism,  67,  68,  114,  178,  183,  184,  207, 

365.  366. 

Angina  pectoris,  184,  185,  367. 
Anopheles,  379,  393. 


Anthrax,  40,  78,  325,  329  et  seq. 

Anthropology,  249,  275. 

Antimony   6,  151. 

Antisepsis,  9,  36,  67,  95,  293,  335  et  seq., 

407  et  seq. 
Antitoxin,  371,  384. 
Antyllus,  67. 
Aorta,  48. 
Aphides,  239. 

Aphorisms,  of  Hippocrates,  36,  39,  83. 
Aplasia  cerebrl,  272. 
Apophysls,  64. 
Apoplexy,  106,  182. 
Apothecaries,  74,  88. 
Apparatus,  36,  54,  99,  231. 
Appendicitis,  12. 

Appendix,  vermiform,  109,  167,  172. 
Aranzi,  115. 

Archigenes,  59,  6r,  62,  75. 
Aretoeus,  59,  62,  78. 
Aristotle,  47,  69,  75,  82,  84,   IIO,  120, 

198. 

Army  Board,  385  et  seq. 
Arrectores  pili,  336. 
Arsenic,  87. 

Arsenophenylglycin,  372. 
Art,  105. 

Arteries,  calcareous,  n,  47,  50. 
Arteritis,  272. 

Arthritis  deformans,  6,  11,  53,  269. 
Ascites,  6. 
Asclepiades,  56. 

Asclepiads  (Asclepiadae) ,  26,  31,  40,  44. 
Asclepieia,  24,  31. 
Asclepios,  23. 
Aselli,  133. 
Asepsis,  407  et  seq. 
Asiatic  cholera,  333. 
Asphyxiation,  279. 
Assurbanipal,  19.    • 
Asthma,  6,  84,  280. 
Asthenia,  cardio-vascular,  404. 
Astrology,  17,  20,  21,  73,  85-88. 
Atavism,  169. 
Atheroma,  12. 
Athletics,  23,  29,  31,  411. 
Atoms,  29,  56. 
Atoxyl,  372. 

Atrophy  of  the  liver,  186. 
Auenbrugger,  200  et  seq. 
Aurum  polabile,  87. 
Auscultation,  40,  201. 
Autopsies,  10,  181,  184,  188,  213. 
Aqua  regia,  87. 
Aqua  vita,  87. 
Avenzoar,  80,  8r,  85. 
Averroes,  80,  82,  83,  84,  91. 
Avicenna,  78,  79,  87,  99.  120. 


4i8 


INDEX 


Babylonia,  I  et  seq. 

Bacillus  anthracis,  317,  327. 

Bacillus  icteroides,  384,  386. 

Bacillus,  Krebs-LSffler,  384. 

Bacillus  pestis,  374. 

Bacillus  tetani,  398. 

Bacillus  tuberculosis,  333. 

Bacillus  typhosus,  396. 

Bacillus  X,  384. 

Bacon,  Francis,  161. 

Bacteriology,  316  et  eeq.,  335.  3S»,  368, 

383,  384,  4". 
Bachtishwa,  73  et  seq. 
Baer,  Karl  Ernst  v.,  238,  343. 
Bagdad,  72,  88,  90. 
Bainbridge,  W.  S.,  407,  414. 
Balfour,  F.  M.,  250,  255. 
Ball,  James  Moores,  115. 
Bandaging,  36,  46,  67,  190. 
Barcelona,  358. 
Bark,  Peruvian,  144,  154. 
Baron,  J.,  180. 
Baskerville,  Charles,  295. 
Bassi,  324. 
Baths,  13,  31,  73. 
Bayard,  Thomas,  353. 
Bayle,  207,  208. 
Beddoes,  Thomas,  277. 
Behring,  Emil  v.,  275,  298. 
Bell,  Benjamin,  367. 
Bell,  Sir  Charles,  218,  221,  236,  311. 
Bellevue  Hospital  Medical  College,  383. 
Bellini,  135,  136. 
Berengario  da  Carpi,  106. 
Beri-beri,  394,  396. 
Bernard,  Claude,  218,  231,  337. 
Bernard  of  Gordon,  85. 
Bert,  Paul,  327. 
Berthelot,  M.,  92. 
Bertuccio,  95,  99. 

Bichat,  181,  189,  208,  215,  257,  263. 
Bigelow,  Henry  J.,  286,  295. 
Bignaml,  381,  387. 
Bilharziasis,  7,  266. 
Bilroth,  349. 
Biogenesis,  321. 
Biology,  313. 
Bischoff,  252. 
Black  Death,  too,  374- 
Bland-Sutton,  Sir  John,  314. 
Blastoderm,  245. 
Blasts,  380. 
Blind,  Karl,  267,  275. 
Bloch,  Iwan,  373. 
Bloch,  Oscar,  353- 
Blocking,  nerve,  410. 
Boerhaave,  138,  157, 182,  201,  218. 
Bologna,  95,  99,  188,  356,  384. 
Bone  grafts,  413. 
Bonetus,  181. 

Bonnet,  Charles,  239,  318. 
Borelli,  135,  136. 
Borgia,  Alexander,  355. 
Boulogne,  412. 

Boyle,  Robert,  140,  144,  159,  323. 
Brain,  28,  109;  b.  surgery,  414. 


Branchial  clefts,  25* 

Breinl,  372. 

Breslau,  369. 

British  Association  for  the  Advancement 

of  Science,  352. 
Bronchiectasis,  215. 
Bronchitis,  215. 
Bronchophony,  214. 
Bronchototny,  114. 
Brooks,  W.  K.,  136. 
Brown,  H.  M.,  373. 
Brown,  J.,  159,  337. 
Brown,  Robert,  258. 
Browne,  E,  G.,  92. 
Brticke,  231. 
Bruit,  placenta!,  216. 
Brunschwig,  Hieronymus,  103. 
Buboes,  358. 
Buckle,  198. 
Buisson,  196. 
Burdach,  K.  F.,  246. 
Burns,  treatment  of  with  paraffin-resin, 

413. 
Burton,  Sir  R.  F.,  93. 

Cabanis,  230. 

Caelius  Aurelianus,  60. 

Caesalpinus,  115,  118,  126. 

Csesarean  operation,  100,  114, 

Calamus  scriptorius,  50. 

Calculi,  ii,  156,  1 86. 

Calkins,  Gary  W.,  373. 

Calmette,  329. 

Camac,  C.  N.  B.,  317. 

Cambridge,  154. 

Camerarius,  218. 

Cameron,  Sir  Hector,  342,  353- 

Camp  Lazear,  388. 

Camper,  157. 

Cancer,  58,  62,  67,  82,  IOO,  350. 

Canine  teeth,  310. 

Cannabis  indie  a,  90. 

Cannanus,  117. 

"  Canon,"  78. 

Cannon,  W.  B.,  404. 

Carbolic  acid,  344,  348. 

Carbon  dioxide,  294. 

Caries,  251. 

Carmine,  251. 

Carpenter,  W.  B.,  198,  335. 

Carrel  treatment,  407  et  seq. 

Carriers,  397. 

Carroll,  James,  384  et  §eq. 

Carter,  H.  R.,  387. 

Case  histories,  40. 

Casualty  clearing  stations,  407  et  seq. 

Cataract,  51,  58,  67,  68,  114,  187. 

Catgut  ligatures,  351. 

Catherine  II,  241. 

Cat  on,  Richard,  44. 

Cautery,  3,  57,  79,  8l,  06,  113. 

Cell  nucleus,  258. 

Cell-theory,  251,  253,  257  et  seq. 

Celli,  376,  377. 

Celsus,  54. 

Cerebrospinal  meningitis,  398,  399. 


INDEX 


419 


Cervical  vertebra,  64, 

Chamberland,  329. 

Chancre,  Hunterian,  367. 

Charles  VIII,  355- 

Chauliac,  Guy  de,  99. 

Chemistry,  87,  158,  192. 

Chemo-receptors,  371. 

Cheselden,  293. 

Chicken  cholera,  328. 

Chladni,  209. 

Chlorination  of  water,  397. 

Chloroform,  288  et  seq. 

Chlorosis,  7. 

Cholera,  274,  334,  343- 

Cholmeley,  H.  P.,  92. 

Chorea,  156. 

Chronic  disease,  41. 

Chylothorax,  205. 

Circulation,  52,  108,  116  et  seq.,  156, 

178,  183,  339. 
Circumcision,  3,  4. 
Civitas  Hippocratica,  94. 
Classification,  258,  308,  313,  317,  326. 
Clement,  384. 
Clift,  174,  175,  i?6. 
Clifton,  Francis,  44. 
Clover,  J.  T.,  294. 
Clowes,  William,  114. 
Cnidus,  24,  27,  31,  40,  51,  59. 
Coagulation,  339  et  seq. 
Coction,  43,  53,  67,  loo. 
Ccelenierata,  254. 
Cohn,  Ferdinand,  260,  326. 
Cohnheim,  Julius,  370. 
College  de  France,  231. 
College  de  Saint  C6me,  in. 
"Colliget,"  82,  84. 
Colon,  393. 

Color-blindness,  179,  314. 
Colot,  Laurent,  114. 
Colton,  G.  Q.,  282,  295. 
Columbus,  M.  R.,  114,  117. 
Columella,  316. 
Coma,  39,  156. 
Comma  bacillus,  333. 
Condylomata,  184. 
Congress  of  Anthropologists,  240. 
Conjunctivitis,  333. 
Constantine  the  African,  84. 
Constitutions,  34,  76,  146,  150. 
Contagium  animatum,  330. 
"Continens,"  75. 

Continuity  of  the  germplasm,  313. 
Contractility,  220,  232. 
Contraction,  135. 
Cooke,  390. 
Cooper,  Astley,  178. 
Copho  the  Younger,  94. 
Cordova,  80. 
Corvisart,  197,  206,  208. 
Cos,  24,  27,  31,  51. 
Coste,  252. 

Councilman,  376,  383. 
Craniology,  249,  279. 
Crasis,  43. 
Creighton,  Charles,  159. 


Cretinism,  274. 

Crisis,  43. 

Critical  days,  28,  42. 

Crotona,  24,  27,  28,  29,  30. 

Crudity,  43. 

Cuba,  385  et  seq. 

Culpin,  M.,  407,  414. 

Culture,  pure,  331  et  seq. 

Cupping,  3,  57,  74.  364. 

Curare,  232. 

Curtis,  J.  G.,  136. 

Cuvier,  176. 

Cyanosis,  186. 

Cycles,  life,  369,  377. 

Da  Costa,  J.  M.,  401,  414. 

D'Alton,  245. 

Damascenus,  74,  84. 

Damascus,  oo. 

Dancing  mania,  156. 

Darius,  30. 

Darwin,  Charles,  160,  170,  174,  241,  250, 

254,  275,  296  et  seq.,  312,  314,  403. 
Davaine,  325,  326. 
Deaf-mutism,  314. 
Deafness,  39,  183. 
Debridement,  407. 
Delafond,  325,  326. 
Delag6niere,  413. 
Delirium,  30. 
Democedes,  29. 
Democritus,  27,  29,  60,  257. 
Dentistry,  u,  13,  18,  81,  165,  177,  180, 

282  et  seq.,  412. 
Desault,  189  et  seq. 
Descartes,  133,  137. 
Development,  arrested,  167,  310. 
Diabetes,  62,  78;  artificial,  235- 
Diagnosis,  39,  ioo,  181,  200  et  seq.,  333. 
Diaphoretics,  20. 
Diathesis,  208. 

Diet,  13,  20,  29,  31,  37,  42,  79.  94,  ISO. 
Dietetics,  84. 
Digestion,  53,  234. 
Dilatation,  12,  206,  207. 
Diodes,  46. 
Dioscorides,  75,  88. 
Diphtheria,  62,  274,  371,  384,  398. 
Diseases,  of  beer,  325;  of  wine,  324. 
Dislocations,  29,  36,  54. 
Disordered  action  of  the  heart,  402. 
Dissection,  49,  54,  59,  60,  91, 96, 104, 108, 

1 20,  1 60  et  seq.,  190. 
Distomiasis,  266. 
Dogmatists,  47,  63. 
Dollinger,  244. 
Dorpat,  244. 
Dorsal  vertebrae,  64. 
Dorsey,  178. 
Dreams,  404-405. 
Dropsy,  156,  206. 
Drugs,  5,  6,  7,  23,  79,  87,  88,  89,  90.  157, 

197,  225. 

Dublin  School,  217. 
Du  Bois-Reymond,  231. 
Duclaux,  Emile,  334. 


420 


INDEX 


Ducrey,  368. 

Dujardin,  260. 

Dumas,  J.  B.,  346,  288,  290,  324. 

Duncan,  289. 

Duodenum,  so. 

Dusch,  y.,  320. 

Dyscrasia,  43. 

Dysentery,  6, 146, 147,333,  394,396,401. 

Ebers  Papyrus,  5  et  seq. 

Eberth,  396. 

Eclectic,  60,  63. 

Ectoderm,  254. 

Edessa,  oo. 

Edinburgh,  336  et  seq. 

Education,  medical,  71,94  et  eeq.,  157, 
158,  201,  218,  231,  335,  383. 

Egypt,  i  et  seq., 

Ehrenberg,  326. 

Ehrlich,  369  et  seq. 

Elder-flowers,  103. 

Elements,  28,  37,  43. 

Elephantiasis,  62. 

Elixir,  86. 

Ellett,  G.  G.,  44. 

Embalming,  2,  8. 

Embottement,  239. 

Embolism,  269,  271,  272. 

Embryology,  48,  131,  171  et  seq.,  238 
et  seq.,  255,  3OI,  309,  310,  336,  340. 

Emesis,  29. 

Emetics,  151. 

Emetine,  401. 

Emotions,  180,  403  et  seq., 

Empedocles,  27,  38. 

Emphysema,  215. 

Empirics,  54,  63. 

Empyema,  79,  201,  204. 

Endemic  diseases,  41. 

Endocarditis,  272. 

Endoderm,  254. 

Enemata,  20. 

Entomaba,  histolitico;  colt,  369. 

Entozoa,  344. 

Epidaurus,  24,  25. 

Epidemic,  41,  144,  147, 153,  154,  158. 

Epigenesis,  132,  145,  238. 

Epilepsy,  4,  18,  35,  42,  62. 

Epiphysis,  64. 

Erasistratus,  49. 

Erichsen,  336. 

Erysipelas,  36,  61,  332,  341. 

Ether,  280,  410  et  seq. 

Ether  frolic,  281. 

Ether  spray,  295. 

Ethyl  chloride;  ethyl  bromide,  294. 

Etienne,  Charles,  114,  117. 

Etiology,  4,  ii,  16,  18,  39,  142,  152,  153, 
156,  158,  330,  331,  377,  386,  388,  396. 

Eugenics,  312,  313. 

Eusol,  409. 

Eustachius,  114,  117,  134. 

Exanthemata,  317. 

Excision,  351,  352. 

Exercise,  29.  See  Athletics  and  Gym- 
nastics. 


Exfoliation  of  the  bone,  36. 

Exostoses,  62. 

Experiment, 37,  47,  49,  55,  60,  64  et  seq., 
76,  78,  79,  82,  88,  108,  122,  128,  132, 
134,  149,  151,  162,  191,  197,  202,  211, 
214,  219,  222,  223,  227,  228,  232,  276, 
277,  279,  28s,  3i8,  319,  338,  351.  390. 

Experimentation,  59. 

Extra-uterine  pregnancy,  81,  373. 

Extrinsic  incubation,  391. 

Eycleshymer,  198. 

Fabricius.  115,  117. 

Fades  Hippocratica,  41. 

Faith  cures,  25. 

Fallopius,  114. 

Faraday,  281. 

Fear,  39,  180.  403  et  seq. 

Feeding,  artificial,  82,  179. 

Ferdinand  II,  Grand  Duke  of  Tuscany, 

130,  135,  158. 
Ferguson,  A.  R.,  21. 
Fergusson,  293. 

Fermentation,  75,  77,  150,  259,  322,  344. 
Ferments,  322  et  seq. 
Fernel,  365. 
Fertilization,  255. 
Fibers,  theory  of,  257. 
Filarice,  61,  79,  266,  375. 
Filariasis,  375. 
Finlay,  386  et  seq. 
Finlayson,  James,  21,  44,  70. 
Flexner,  Simon,  398. 
Flourens,  237,  289,  294.    . 
Fluorescent  screens,  411. 
Fomentations,  29. 
Fomes,  153,  389. 
Fossils,  173,  174,  302,  307. 
Foster,  Sir  Michael,  136,  237. 
Fracastorius,  354. 
Fractures,  12,  16,  29,  36,  60,  98,  99,  "3, 

182,  100,  344,  345,  350,  411  et  seq. 
Franco,  Pierre,  114. 
Fremont,  316. 
Friedreich's  ataxia,  314. 
Fuchsin,  370. 
Fumigations,  5,  20,  365,  382,  392  et  seq. 

Gaddesden,  John  of,  84,  92. 

Galapagos  Archipelago,  296. 

Galen,  63,  74,  75,  84,  99,  106,  107, 108. 

Galileo,  118,  135. 

Gall-stones,  n. 

Gametocytes,  377,  380. 

Gangrene,  36,  57,  215,  339. 

Garrison,  313. 

Gas  gangrene,  413. 

Gastrula,  254. 

Geber,  86. 

Geddes,  Patrick,  275. 

Gegenbaur,  254. 

Genoa,  356. 

Geographical  distribution,  249,  301,  307, 

308. 

Geological  succession,  308. 
Geology,  173. 


INDEX 


421 


George  II,  219. 

Gerard  of  Cremona,  84. 

Gerlach,  v.,  251. 

German  Cholera  Commission,  333. 

Germinal  continuity,  251,  266,  267. 

Germinal  layers,  245  et  seq.,  254. 

Germinal  spot,  252. 

Germinal  vesicle,  252. 

Gersdorff,  Hans  v. ,  103. 

Gilbert  the  Englishman,  84. 

Gillies,  H.  D.,  414. 

Glioma,  243. 

Glisson,  132,  134. 

Globules,  theory  of,  257. 

Glycogen,  234. 

Glycosuria,  experimental,  235. 

Goddard,  140. 

Godlee,  Sir  Rickman,  341,  353. 

Godman,  281. 

Goitre,  exophthalmic,  274,  404. 

Golgi,  251,  376. 

Gondisapor,  71,  88. 

Gonorrhoea,  iss,  187,  364,  366  et  seq. 

Gordon,  Laing,  295. 

Gorgas,  W.  C.,  388  et  seq. 

Gottingen,  219. 

Gout,  6,  12,  148,  156,  168. 

Gracfe,  Albrecht  v.,  338,  350. 

Graham,  Thomas,  335. 

Grand  Palais,  407. 

Graphiscus,  41. 

Graves's  disease,  274,  404. 

Gray,  Asa,  301. 

Gray,  Sir  H.  M.  W.,  408  et  seq. 

Greenhill,  W.  A.,  92. 

Gross,  S.  D.,  1 80. 

Guaiac,  359,  361. 

Guerini,  Vincenzo,  180. 

Gtiillemeau,  114. 

Gummata,  184,  366. 

Gunshot  wounds,  103,  409. 

Guthrie,  288. 

Gwathmey,  J.  T.,  295. 

Gymnasium,  23,  29,  31. 

Gymnastics,  411. 

Hadley,  P.  B.,  237. 

Haeckel,  256,  310,  313. 

Heemamabida,  379. 

Haematoidin,  271. 

Haematology,  370. 

Haematuria,  5,  7. 

Hiemocytozoa,  376. 

Haemophilia,  81,  314. 

Haemorrhage,  19,  56,  60,  96,  183,  271, 

409. 

Haemothorax,  205. 
Haen,  Anton  de,  157,  201. 
Haldane,  Elizabeth  S.,  137. 
Hall,  Marshall,  218,  226,  237. 
Haller,  157,  218,  229,  241,  257. 
Hallier,  326. 
Haly  Abbas,  78. 
Hammurabi,  Code  of,  14, 
Haptophores,  371. 
Harets  ben  Kaladah,  71. 


Harley,  295. 

Harrier,  R.  F.,  31. 

Harun  al  Rashid,  72. 

Harvard  Medical  College,  283,  287. 

Harvey,  115,  116,  238,  246,  268. 

Hata,  372. 

Havana,  386  et  seq. 

Hayward,  286. 

Healing  by  first  intention,  36. 

Hearst  papyrus,  8. 

Heart-block,  186;  h.  surgery,  414. 

Heberden,  185. 

Heizmann,  115. 

Heliodorus,  59,  61,  62. 

Helmholtz,  231. 

Hematoma,  273. 

Henle,  234,  330. 

Henley,  346. 

Henslow,  279,  299. 

Hepatoscopy,  18. 

Heraclides,  54. 

Heredity,  313. 

Hermaphrodites,  170. 

Hernandez,  367. 

Hernia,  58,  68,  82,  114,  172,  185. 

Herodicus,  29. 

Herodotus,  13. 

Herold,  252. 

Herophilus,  49,  65. 

Hertwig,  Oscar,  255. 

Heterochronia,  270. 

Heterology,  270. 

Heterometria,  270. 

Heterotopia,  269,  270. 

Highmore,  132,  140. 

Hindus,  88. 

Hippocrates,  I,  23-45,  46,  74,  139,  148, 

187.  209. 

His,  Wilhelm,  252. 
Hispaniola,  354  et  seq. 
Histology,  48,  181  et  seq. 
Holmes,  B.  T.,  21. 
Holmes,  Oliver  Wendell,  286. 
Home,  Sir  Everard,  175,  185. 
Homology,  270,  309. 
Honain,  74,  84. 
Hong-Kong,  374,  382. 
Hooke,  Robert,  34,  257,  264. 
Hookworm  disease,  7,  394,  396. 
Hopkins,  A.  J.,  92. 
Hoppe-Seyler,  274. 
Hopstock,  H.,  115. 
Hospital  gangrene,  341. 
Hospitalism,  342. 

Hospitals,  71,  ?8,  oo,  274,  286,  342. 
H6tel  Dieu,  208,  231. 
Humors,  42,  150,  273,  275. 
Hunter,  John,  160  et  seq.,  185,  229,  243f 

340,  366,  367,  411. 
Hunterian  Museum,  160,  176. 
Hutchinson,  Sir  Jonathan,  372. 
Hutton,  James,  296. 
Huxley,  T.  H.,  258. 
Hydatids,  179. 

Hydropericardium,  205,  207. 
Hydrophobia,  187,  329. 


422 


INDEX 


Hydro-pneumothorax,  215. 
Hydrpthorax,  205,  213. 
Hygeia,  24,  33. 
Hygiene,  13,  94,  150,  157. 
Hygienic  Institute,  333. 
Hyoscyamus,  95. 
Hyperplasia,  270. 
Hypertrophy,  270. 
Hypochlorites,  408. 
Hypochondriasis,  156. 
Hypodermic  syringe,  294. 
Hyrtl,  92. 

Hysteria,  18,  156,  403  et  seq. 
Hysterical  anaesthesia,  406. 
Hysterical  paralysis,  25,  406. 

latreia,  90. 

Ibn  Baitar,  89. 

Imhotep,  3. 

Immediate  closure  of  wounds,  407. 

Immunity,  162,  314,  328,  370  et  seq., 

396. 

Imperial  Health  Bureau,  332,  368. 
Impotence,  34. 
Incubation,  24;  extrinsic,  391;  intrinsic, 

391. 

India,  90. 

Inflammation,  58,  338. 
Influenza,  147,  399-400. 
Infusoria,  317. 
Ingrassias,  115. 

Inhalations,  6,  100,  103,  276  et  seq. 
Inheritance,  313,  314. 
Institute  for  Infectious  Diseases,  333- 
Instruments,  4,  15,  36,  46.  53,  58,  62,  81, 

101,  113,  134.  137,  238,  244,  255,  257. 
Internal  secretions,  235,  404. 
International  Medical  Congress,  333. 
Interossei  muscles,  64. 
Intrinsic  incubation,  391. 
Inunctions,  6,  29,  360,  364,  391. 
Inventum  Novum  of  Auenbrugger,  aoo. 
Iodide  of  potassium,  373. 
Irritability,  220,  232. 
Isagoge,  8|. 

Isla,  Ruy  Diaz  de,  357  et  seq. 
Ismailia,  382. 
Israel,  Oscar,  275. 
Isaac  ben  Honain,  77. 
Isaac  Judaeus,  79. 
Itch,  82. 

Jackson,  Charles,  T.,  283. 
James,  William,  403. 
Jastrow,  Morris,  Jr.,  21. 
Jaundice,  18,  73,  186,  402. 
Jenner,  Edward,  185,  328. 
Jenner,  William,  335. 
Jernigan,  300. 
Joachim,  H.,  21. 
Johns  Hopkins  University,  283. 
Jones,  Sir  Robert,  411  et  seq. 
Jones,  Wharton,  335. 
Jones,  W.  H.  a,  44. 
Joubert,  327. 
Joylifle,  George,  134. 


Junker  Inhaler,  294. 

Kahun  papyrus,  8. 

Kees,  John,  120. 

Keith,  Sir  Arthur,  180. 

Keith,  Dr.,  289. 

Kelly,  H.  A.,  295,  394. 

Kepler,  133. 

Keratitis,  273. 

Kergaradec,  216. 

King's  College,  London,  350. 

Kircher.  316. 

Kissinger.  389. 

Kitasato,  374.  308. 

Kitterman,  P.  G.,  21. 

Klebs-Ldffler  bacillus,  384. 

Knopf,  S.  A.,  334- 

Koch,  7,  275,  326  et  seq.,  382. 

Kolle,  396. 

Kolliker,  v.,  253,  261,  267,  336. 

Kowalewsky,  254. 

Lae'nnec,  200  et  seq. 

Lancet,  349. 

Lancisi,  316,  366. 

Lanfranchi,  97,  98. 

Langenbeck,  293. 

Lankester,  E.  R.,  394. 

Laparotomy,  47. 

Las  Animas  Hospital,  388,  390. 

Las  Casas,  361. 

Laughing  gas,  282. 

Laveran,  Alphonse,  376. 

Law,  The,  32. 

Lazear,  385  et  seq. 

Leeuwenhoek,  136,  238,  316. 

Leibnitz,  239. 

Leishman,  397. 

Lelean,  Percy,  414. 

Le  Mans,  412. 

Leonardo  da  Vinci,  104,  115,  130,  268. 

Leonides,  59,  61,  79. 

Leonliasis  ossea,  273. 

Leprosy,  61,  79,  90,  100,  114,  274. 

Leucocytosis,  271. 

Leucorrhoea,  6. 

Leukaemia,  271. 

Levy,  Reuben,  93. 

Liber  regis,  78. 

Liebig,  287. 

Ligature,  56,  61,  67,  79,  81,  98,  112. 

Linacre,  121. 

Liniments,  20. 

Linnaeus,  317. 

Lister,  Lord,  57,  252,  294,  335  et  seq. 

Lister,  Joseph  Jackson,  251,  335. 

Liston,  Robert,  287,  294. 

Lithotomy,  33,  54,  58,  114,  293. 

Liverpool  School  of  Tropical  Medicine, 

372. 

Locke,  140. 

Locy,  W.  A.,  115,  250,  257. 
Loffler,  Friedrich,  334,  384. 
Long,  C.  W.,  281,  295,  3i6. 
Lourdes,  24. 
Lou  vain,  1 06. 


INDEX 


423 


Lower,  Richard,  134,  140. 

Lucas-Championniere,  349,  353. 

Lucca,  Hugh  of,  95. 

Lucretius,  316. 

Lumbago,  6. 

Lumbar  vertebrae,  64. 

Lunar  caustic,  87. 

Lupus,  273. 

Lusk,  W.  T.,  159. 

Lyell,  Sir  Charles,  296  et  seq. 

Lyons,  189. 

MacCallum,  W.  G.,  381. 

McCrae,  Thomas,  159. 

Machaon,  24. 

McMurrich,  J.  P.,  115. 

Magendie,  218,  224. 

Maimonides,  Moses,  80,  83. 

Malaria,  12,  28,  41,  143,  149,  154,  376 

et  seq.,  384  et  seq.,  396. 
Malformations,  312,  314. 
Malgaigne,  36. 

Malpighi,  127,  I3S.  182,  188,  238,  241. 
Malta  fever,  396. 
Malthus,  168,  300,  302. 
Mandragora,  95. 
Manson,  Sir  Patrick,  375  et  seq. 
Maria  Theresa,  200. 
Marchiafava,  376,  377- 
Marinus,  59,  63. 
Marne,  first  battle  of,  398. 
Martius,  244. 
Marx,  K.  F.  H.,  70. 
Massage,  20,  29,  411. 
Masters,  W.  E.,  395. 
Mastoiditis,  12. 
Mattioli,  365. 

Maximilian  I,  Emperor,  357. 
Mayow,  John,  134. 
Measles,  75,  146,  152. 
Meckel,  J.  F.,  176,  243. 
Medical  education,  91. 
Medical  jurisprudence,  15. 
Medicine,  experimental,  235. 
Melanin,  379. 

Meningitis,  cerebrospinal,  398,  399. 
Meningococcus,  399. 
Menuret,  316. 
Mercuriada,  95. 
Mercury,  6,  76,  77,  90,  151,  156,  316, 

359,  364,  367,  373. 
Messua  the  Elder,  74,  77,  9O. 
Messua  the  Younger,  89. 
Metchnikoff,  329,  368. 
Methodic  School,  56,  63. 
Methylene,  370. 
Meunier,  Leon,  70,  217. 
Micrococcus,  326,  332. 
Microscope,  193,  244,  251,  257. 
Microtome,  252,  336. 
Mikulicz-Radecki,  v.,  349,  353- 
Miller,  Professor,  290. 
Milo,  29,  30. 
Minot,  C.  S.,  255,  256. 
Mitchell,  Weir  S.,  136. 
Mohammed,  71. 


Mohl,  v.,  360. 

Molyneux,  William,  136. 

Mondeville,  Henri  de,  98. 

Mondino,  95,  97,  106. 

Montgomery,  T.  H.,  373. 

Montpellier,  85,  97,  98,  99,  189. 

Moodie,  R.  L.,  21. 

Moore,  Norman,  137. 

Moran,  389. 

Morgagni,  181,  184,  187,  199,  268,  365. 

Morton,  W.  T.  G.,  283. 

Mosquitoes,  375  et  seq.,  387  et  seq. 

Mott,  F.  W.,  403  et  seq. 

Mott,  Valentine,  178. 

Mailer,  Fritz,  254. 

Mailer,  Johannes,  218,  228,  253,  260,  273. 

Miiller,  Otto  Friedrich,  317. 

Mailer,  W.  Max,  21. 

Mycoderma  aceti,  323. 

Mycoses,  266,  324. 

Naegeli,  324. 

Naples,  354. 

Napoleon,  195,  197,  206. 

Natron,  6,  10. 

Xausea,  39. 

Necatar  americanus,  7. 

Needham,  318. 

Neisser,  368. 

Neo- Darwinians,  313. 

Neoplasm,  270. 

Nero,  59- 

Nerve  blocking,  410. 

Nerves,  40  et  seq.,  58,  218  et  sen.;  spe- 
cific energy  of,  179,  220;  cranial,  222; 
spinal,  221,  229. 

Nervous  system,  191,  251. 

"  Nestor,"  400. 

Nestorian  physicians,  71,  90. 

Neuralgia,  18. 

Neurasthenia,  403. 

Neuroglia,  269. 

Neurology,  49  et  seq.,  60,  6s,  191,  218  et 
seq.,  411. 

Neuron,  49. 

Neurotomy,  98,  114. 

Nicholas  of  Salerno,  95. 

Nicolaier,  398. 

Nitrous  oxide,  277.  et  seq.,  410. 

Notochord,  246,  259. 

Novara,  356,  357,  363. 

Number  lore,  27  et  seq. 

Nunneley,  294. 

Nureddin.  91. 

Nursing,  274. 

Nussbaum,  v.,  348,  349. 

Nuttall,  383.  /  4<t~/ 

Oath,  The,  33.  /     . 

Obstetrics,  si,  58,  79,  81,  too,  114,  287 

et  seq. 

Odontology,  177. 
CEdema,  215. 
Omne  vivum  e.x  ova,  246. 
Omnis  celluta  e  cellula,  267,  268. 
Ontogeny,  313. 


424 


INDEX 


Ophthalmology,  74,  91. 

Ophthalmometer,  231. 

Ophthalmoscope,  231. 

Opium,  46,  55. 

Organic  evolution,  251,  296  et  seq. 

Organs,  rudimentary,  301,  309. 

Oribasius,  68,  74. 

Orthopaedic  Centers,  411  et  seq. 

Orthopaedic  surgery,  411  et  seq. 

Osborn,  H.  F.,  314. 

Osier,  Sir  William,  159,  207,  216,  363, 

377,  394.  395- 
Osteology,  SS,  65.  74- 
Osteoperiosteal  grafts,  413. 
Ostia,  381. 
Ottley,  Drewry,  180. 
Oviedo,  360. 
Ovum,  246,  252,  254. 
Owen,  Richard,  174,  I7S,  176,  180,  250. 
Oxford,  130. 

Oxygen,  276 et  seq.,  295,  34$!  410. 
Oianam,  316. 

Padua,  107,  188. 

Paget,  Sir  James,  295. 

Paget.  Stephen,  115,  180. 

Paleontology,  173,  174,  302,  307. 

Palmer,  J.  F.,  180. 

Palpation,  40. 

Palsy,  Bell's,  223. 

Panacea,  24,  33. 

Panama,  393  et  seq. 

Pancreatic  juice,  236. 

Pander,  C.  H..  245. 

Pangenesis,  313. 

Panniculus  carnosus,  311. 

Paracelsus,  365. 

Paraffin-resin  treatment,  413. 

Paralysis,  36,  62;  artificial,  223;  hyster- 
ical. 25,  406;  infantile,  12. 

Parasites,  266. 

Parasitology,  374. 

Paratyphoid,  397. 

Pare,  Ambroise,  in  et  seq. 

Parthenogenesis,  239. 

Pasteur,  320  et  seq.,  344,  345,  346,  352. 

Pasteur  Institute,  329. 

Pathology,  181  et  seq.,  257  et  seq.,  314, 
333. 

Paul  of  /Egina,  68,  74,  T9,  81. 

Payne,  J.  F.,  159. 

Pearly  disease  of  cattle,  374. 

P6brine,  324. 

Pecquet,  134. 

Pectoriloquy,  212,  214. 

Pellagra,  274. 

Pemphigus,  6. 

Penicillium  glaucum,  333. 

Pepsis,  43. 

Percussion,  201. 

Pergamus,  24,  63. 

Peritonitis,  196. 

Petit,  Antoine,  189. 

Petty,  140. 

Peyer's  patches,  273. 

Pfeilier,  396. 


Pfolspeundt,  102. 

Pharmacopoeia,  4,  6,  17,  ao,  88,  89. 

Pharmacy,  5,  6,  7,  23,  79,  87,  88,  89,  90. 

157,  197,  225. 
Philosopher's  stone,  86. 
Philosophers,  27,  38. 
Philosophy,  23,  28,  29,  38,  141,  150. 
Phimosis,  58. 
Phlebitis,  271,  272. 
Photography,  332. 
Phthisis,  42,  62,  156,  212  et  seq. 
Physick,  178. 
Physiology,  28,  38,  43,  116  et  seq.,  150, 

191  et  seq.,  218  et  seq.,  230,  314. 
Picard,  Frederic,  159. 
Pilcher,  L.  S.,  us. 
Pinar  del  Rio  Barracks,  386. 
Pinzon,  360. 
Pirogoff ,  288,  293. 
Plague,  61,  100,  113,  130,  145,  154,  334, 

374.  394- 

Plasmodia,  369,  376  et  seq. 
Plasters,  6. 

Plastic  surgery,  67,  68,  103,  413,  414. 
Platysma,  64. 
Plenciz,  316. 
Plethora,  S3. 

Pleurisy,  12,  46,  47,  196,  201,  313. 
Pleuritic  friction,  40. 
Pneuma,  47,  52,  66,  128. 
Pneumatic  doctrine,  63. 
Pneumatic  Institution,  277. 
Pneumococcus,  328. 
Pneumohydrothorax,  40. 
Pneumonia,  46,  186,  196,  215. 
Podalirius,  24. 
Pollender,  326. 
Polydactylism,  314. 
Popliteus  muscle,  64. 
Poppy,  S. 
Pores,  56. 
Post,  Wright,  178. 

Post-mortem,  51,  32,  181  et  seq.,  201. 
Posture,  erect,  167. 
Pottevin,  329. 
Pott's  disease,  10,  41. 
Poultices,  20. 
Poulton,  E.  B.,  315. 
Power,  D'Arcy,  137. 
Praxagoras,  46. 
Predelineation.  239. 
Preformation.  239. 

Pregnancy,  216;  extra-uterine,  81,  273. 
Preventive  inoculations,  396. 
Preventive  medicine,  374  et  seq. 
Prevost,  246. 
Priestley,  276,  277. 
Priest-physicians,  I  et  seq. 
Primary  union,  58. 
Primary  Avound  suture,  408. 
"Principles  of  Geology,"  298,  302. 
Pringle,  157. 
Prinzing,  Friedrich,  159. 
Prognosis,  41,  150,  202. 
Prophylaxis,  297. 
Prostate,  si,  167. 


INDEX 


425 


Prosthetic  devices,  58,  113,  113,  414. 
Protoplasm,  251,  260. 
Protozoa,  369,  3(75. 
Protozoology,  368. 
Psychiatry,  78,  91,  402. 
Psychoanalysis,  405  et  seq. 
Psychology,  179,  180,  230,  312,  402  et 

seq. 

Ptolemy  Philadelphia,  49. 
Ptolemy,  Soter,  49. 
Puerperal  fever,  41,  179. 
Pulse,  7,  47,  51. 
Pulsilogium,  119,  133. 
Purgation,  13,  29. 
Purgatives,  20. 
Purkinje,  252. 
Putrefaction,  77,  343,  344. 
Pyaemia,  271,  332,  341. 
Pyogenic  infections,  n. 
Pyo-pneumothorax,  215. 
Pyrcthrum  powder,  352. 
Pyrexia  of  uncertain  origin,  403. 
Pythagoras,  27,  38. 

Queen  Victoria,  293. 

Queen's  Hospital,  Sidcup,  413. 

Quinine,  371,  382. 


Radiographs,  stereoscopic,  411. 

Radiography,  410-11.. 

Rales,  210,  215. 

Ramazzini,  182,  183. 

Rapallo,  355,  356. 

Rasori,  316. 

Rathke,  246,  252. 

Raver,  326,  327. 

Reaumur,  316. 

Recapitulation  theory,  243,  255. 

Redi,  318. 

Reduction,  36. 

Reed.  Walter,  382  et  seq. 

Reflexes,  226  et  seq. 

Reichert,  253. 

Remak,  253.  260,  267,  269. 

Resection,  58,  62,  67,  413. 

Respiration,  41,  105;  artificial,  134. 

Resuscitation,  179. 

Rele  mirabile,  109. 

Rhazes,  75,  87,  91,  93. 

Rheumatism,  18. 

Rhinoplasty,  103,  413,  414. 

Rice,  Nathan  P.,  295. 

Richard,  375- 

Richardson,  Sir  Benjamin,  294. 

Rickets,  10. 

Ricord,  367. 

Rinderpest,  334. 

Robespierre,  189. 

Robinson,  J.  H.,  355. 

Koger,  Henri,  334. 

Roger  of  Palermo,  94. 

Rokitansky,  338. 

Roland  of  Parma,  94. 

Rome,  350,  356. 

Rosato,  363. 


Rosenau,  M.  J.(  395. 

Ross,  Sir  Ronald,  44,  375,  378  et  seq., 

387,  395- 
Roth,  M.,  115. 
Rousset,  114. 
Roux,  329,  368. 
Rovigno,  368. 

Royal  College  of  Physicians,  123. 
Royal    Infirmary,    of    Edinburgh,    290, 

337  et  seq.;  of  Glasgow,  341  et  seq. 
Royal  Society  of  London,  352. 
Rudbeck,  134. 
Ruffer,  Sir  M.  A.,  21. 
Rufus,  59,  63,  75- 
Rupture,  167. 
Russell,  Major,  397. 

Sacred  disease,  35. 

Sainte  Anne  de  BeauprS.  24. 

St.  Hilaire,  Isidore  Geoffrey,  313. 

Sal  Ammoniac,  20. 

Salerno,  94. 

Saliceto,  William  of,  93,  96,  97,  too. 

Salivation,  81,  156. 

Salvarsan,  373. 

Salves,  20. 

Sambon,  381. 

Sanarelli,  384  et  seq. 

Sanctorius,  133. 

Sanitation,  261,  274,  334,  381,  386  et  seq. 

Santo  Domingo,  354  et  seq. 

Sarsaparilla,  365. 

Satyriasis,  62. 

Saxtorph,  347. 

Scarborough,  132. 

Scarlatina,  156. 

Schaudinn,  368,  369. 

Scheele,  277. 

Schelling,  244. 

Schistosoma  hasmatobium,  7. 

Schizomycetes,  326. 

Schleiden,  258. 

Schroder,  320. 

Schulze,  Franz,  320. 

Schwann,  253,  257  et  seq.,  320,  323,  346. 

Science  and  practice,  138  et  seq. 

Scillaccio,  363. 

Sclerosis,  373. 

Scott,  W.  B.,  315. 

Screens,  fluorescent,  411. 

Scrofula,  168,  213. 

Scurvy,  6,  73. 

Secondary  sexual  characters,  171,  312. 

Secretion*,  internal,  235. 

Sedgwick,  246,  297,  299. 

Segmentation  of  the  yolk,  248. 

Selection,  artificial,  300,  304;    natural, 

300  et  seq. 
Semnielweiss,  352. 
Sensibility,  220,  232. 
Sepsis,  409. 

Septiocmia,  328,  332,  341. 
Septum,  interventricular,  no,  116,  123. 
Serapion  the  Elder,  74,  84. 
Serapion  the  Younger,  89. 
Sergius,  75. 


426 


INDEX 


Serology,  308  et  seq. 

Servetus,  114,  116. 

Seville,  360,  362. 

Sforza,  Ludovico,  363. 

Sharpey,  335,  337. 

Shell  shock,  403  et  seq. 

Shock,  341. 

Sidcup,  plastic  surgery  at,  412. 

Siebold,  v.,  246,  252. 

Silver  nitrate,  251. 

Simpson,  Sir  James  Young,  287  et  seq., 

342- 

Singer,  Charles,  45,  93,  US- 
Skoda,  20 1. 

Sleeping  sickness  (trypanosomiasis) ,  334. 
Smallpox,    ii,    75,   146,   151,   152,  162, 

274- 

Smith,  Theobald,  377. 
Snow,  John,  294. 
Soldier's  heart,  401,  414. 
Soranus,  59,  79. 
Soubeiran,  288. 
Souffle,  215. 
Spallanzani,  319,  326. 
Special  Creation,  307. 
Special  Military  Surgical  Hospitals,  411 

et  seq. 
Species  of  disease,  41,  62,  147,  148,  155, 

363,  366. 

Specifics,  144,  149,  369  et  seq. 
Spencer,  Dr.  H.,  93. 
Spermatozoa,  238,  253,  354. 
Spina  tentosa,  77. 
Spirillum,  326. 
Spirits,  87. 
Spirochoita,  326,  369. 
Splenic  fever,  325. 
Splints,  3,  12,  99,  101,  412. 
Spontaneous  generation,  158,  266,  318, 

322,  334- 

Sporadic  cases,  153. 
Spores,  324.  327,  330,  331,  380. 
Sporulation,  326,  376. 
Sprains,  29,  412. 
Staining,  332,  37O. 
Staphylococcus  pyogenes,  328. 
Staphyloplasty,  114. 
Steam  baths,  29. 
Steel,  151. 

Stegomyia,  387,  388,  391,  393. 
Stensen,  I3S,  136. 
Stereo-chemistry,  323. 
Sternberg,  G.  M.,  377,  384  et  seq. 
Stethoscope,  211. 
Stirling,  William,  180,  237. 
Stokes,  1 86, 
Stoll,  201,  206. 
Strassburg,  369,  37O. 
Streptococcus  pyogenes,  328. 
Stromeyer,  348. 
Struggle  for  life,  301,  306,  314. 
Succussion,  40. 
Sudhoff,  Karl,  373. 
Suggestion,  405  et  seq. 
Sulphur  baths,  365. 
Surgery,  3  et  seq.,  36,  46  et  seq.,  79,  80. 


81,  82,  94  et  seq.,  160  et  seq.,  276  et 

seq.,  335  et  seq.,  407  et  seq. 
Suture,  of  the  intestines,  58,  95,  96,  100; 

of  the  nerves,  96,  413. 
Survival  of  the  fittest,  301,  314. 
Swammerdam,  136,  158,  238. 
Swieten,  Van,  157,  201. 
Sydenham,  138-159,  182,  366,  372,  374. 
Sylvius,  Jacobus,  107,  112. 
Syme,  287,  337,  346,  351. 
Symphysis,  64. 
Syncope,  62. 
Syphilis,  10,  114,  155,  184,  273,  354  et 

seq. 
Systema  Natures,  317. 

Tcenia  solium,  266,  267. 

Tagliacozzi,  114. 

"Tasrif,"  81. 

Technique,  332. 

Telesphorus,  24. 

Temperature,  39. 

Temple  priests,  31. 

Temples  of  health,  23,  24,  90. 

Tendon  transplantation,  413. 

Tenesmus,  39. 

Teratology,  170,  249,  312. 

Tetanus,  36,  62,  98,  187,  226,  343,  308. 

Thayer,  W.  S.,  217,  377,  383. 

Theodoric,  95,  98,  99. 

Therapeutics,  194,  197,  274,  371. 

Therapia  sterilisans,  371. 

Thermometer,  157,  177. 

Thermoscope,  119,  133,  135. 

Theurgy,  26,  29. 

Thiersch,  349. 

Thomas,  H.  O.,  411;  leg  and  arm  splints, 

412. 

Thompson,  D'A.  Wentworth,  69. 
Thomson,  Allen,  340. 
Thoracentesis,  68. 
Thoth,  37. 
Thrombosis,  271. 
Tierney,  M.  A.,  137. 
Tissues,  transplantation  of,  177. 
Torcular  Herophili,  49. 
Torre,  M.  A.  della,  104. 
Toulouse,  99. 

Tour,  Cagniard  de  la,  322. 
Tourniquet,  351. 
Toussaint,  328. 
Toxophores,  370, 
Trachea,  52. 
Tracheotomy,  56,  82. 
Trajan,  59. 

Transmission,  386,  396,  401,  409 
Transplantation,    of    tendons,    413;    of 

tissues,  177. 
Trench  fever,  401. 
Trench  foot,  401. 
Trench  nephritis,  401. 
Trephining,  3,  36,  58,  413. 
Treponema  pallidum,  368;   T.   pertenue, 

371. 

Trichina  spiralis,  266. 
Tropical  medicine,  334, 374  et  seq. 


INDEX 


427 


Trypan  red,  372% 

Trypanosonta  noctuas,  369. 

Trypanosomiasis,  372,  396. 

Tubercles,  207,  313,  370. 

Tuberculin,  333. 

Tuberculosis,  82,  186,  273. 

Tubingen,  218. 

Tuffier,  414. 

Tumors,  6,  8,  62,  272,  273, 

Turner,  Sir  William,  70. 

Tyndall,  334. 

Typhoid  fever,  335,  385,  386,  396  et  seq. 

Typhus  fever,  131,  145,  261,  334,  335, 

401. 
Tyson,  James,  275. 

Ulcers,  5,  67,  114,  367. 
Uniformitarian  doctrine,  296. 
Universities,  early,  94. 
University  College  (London),  335. 
University  of  Glasgow,  340. 
University  of  Pisa,  119,  135. 
University  of  Virginia,  383. 
Urethrotomy,  58,  62. 
Urine,  79,  84. 

Vaccination,  162. 

Vaccines,  373,  397. 

Val-de-grace,  412. 

Valentin,  253. 

Valetudinaria,  90. 

Vallery-Radot,  Ren6,  328. 

Vallisneri,  316. 

Valsalva,  181,  182,  188. 

Valves,  52,  117,  121,  125,  127,  133,  186. 

Variation,  168,  169,  300,  301,  304,  306. 

Varolius,  115. 

Varro,  316. 

Veins,  46. 

Venable,  James,  281. 

Venereal  disease,  10,  114,  154,  155,  156, 

179, 183, 184, 187,  273, 3i6, 354 et  seq., 

414. 

Venesection,  3,  56,  58,  74,  100. 
Vermiform  appendix,  109,  167,  172,  310. 
Vermifuges,  5. 
Vesalius,  106-115,  263. 
Vestigial  structures,  310,  314. 
Veterinary  surgeon,  16. 
Vibrio,  317. 
Vidius,  114. 

Vienna  School,  Old,  New,  201. 
Villanova,  Arnold,  97. 


Virchow,  188,  190,  331,  253,  260,  275, 

267, 

Vis  medicalrix  naturae,  25,  43,  80,  150. 
Vivisection,  47,  54,  59,  60,  64,  108,  122, 

219,  222,  227,  232,  236. 
Vocational  training,  411. 
Volkmann,  v.,  349. 

Wagner,  253. 

Walcher  position,  8r,  93- 

Waldie,  289. 

Wallace,  Alfred  Russel,  302. 

Walsh,  J.  J.,  109,  217. 

Warfare,  modern,  396  et  seq., 

Walter,  196. 

War  neuroses,  403  et  seq. 

Warren  J.  C.,  178,  280,  284. 

Weichselbaum,  398. 

Weigert,  332,  370. 

Weismann,  313,  315. 

Welch,  W.H.,  us,  383, 384. 

Wells,  Horace,  282,  295. 

Wharton,  132,  134,  140. 

Wheeler,  W.  M..  256. 

Whitman,  C.  C.,  256. 

Wilson,  E.  B.,  275. 

Winslow,  218. 

Willems,  412. 

Willis,  132,  134,  137,  140,  153. 

Willow,  20. 

Wirsung,  Georg,  134. 

Wisdom-teeth,  310. 

Withington,  E.  T.,  45,  181. 

Wolff,  Christian,  241. 

Wolff,  K.  F.,  240,  245,  248,  257. 

Wolffian  bodies,  240,  310. 

Wood,  Alexander,  294- 

World  War,  396  et  seq. 

Wounds,  gunshot,  178. 

Wren,  134,  140. 

Wright,  Sir  Almroth,  396  et  seq. 

WUrzburg,  244,  261. 

Yaws,  155,  366,  372. 
Yeast,  322,  325. 
Yellow  fever,  384  et  seq. 
Yersin,  329,  374. 
Young,  H.  H.,  295. 

Zerbl,  104. 

Zoological  Station  at  Naples,  255. 

Zy gates,  379,  380. 


Date  Due 


JUN  1  i  1974 

JUN  IB  1P74 

MSL  LIBRARY 

A»n  b  Qlf75 

ArK  kj  v  »«•>'  J 
APR  2  0  1975 

PRINTED   IN    U.S.A.  CAT.      NO.      24       161 


UC  SOUTHERN  REGIONAL  LIBRARY  FACILITY 


A  000  498  857  2 


WZ 


no  ace.  no. 


Libbv 


AUTHOR 


The  history  of  medicine 
— 


TITLE 


no  ace .  no . 


WZ 
kO 


Libby 

The  history  of  medicine 


1922 


DC-CCM  LIBIWRy 


